Evaluating multi-criteria decision-making in health technology assessment

Objectives

Literature has emphasized the role of multi-criteria decision analysis (MCDA) in improving consistency and comprehensiveness of health technology assessment (HTA), however there has been no evidence to indicate this as true. We sought to understand if MCDA ensures systematic and comprehensive HTA.

增量成本效果比在卫生技术评估中的应用

国际上增量成本效果比在卫生技术评估中得到了广泛的应用,为卫生决策制定提供了依据。本文综述了增量成本效果比的基本概念、意义及演进过程,并以案例分析详细阐述了其在卫生决策制定中的应用,以推动卫生技术评估成为我国合理利用卫生资源、提高卫生服务效率的有效方法和手段。     

卫生技术评估的进展

卫生技术指用于卫生保健领域和医疗服务系统的特定知识体系。卫生技术评估主要评估技术的有效性、安全性、经济性与社会影响。在国际有关学术组织的协调下,一些技术评估中心对体外受精、骨密度测定、大型医用仪器、设备等技术进行了评估,得出了一些对决策有影响的信息与建议。其信息还广泛应用在当前卫生改革与卫生技术管理中。     

我国卫生技术评估与决策转化研究概述

卫生技术评估在国际上已经得到广泛应用,并成为各国卫生决策的重要组成部分,发挥着越来越重要的作用。本文通过描述卫生技术的相关利益方,回顾卫生技术评估及转化的国际经验及潜在的影响因素,在结合我国卫生技术评估政策转化实际情况的基础上,提出了卫生技术评估知识转化程度测量、政策决策方和卫生技术评估研究方影响知识转化的因素挖掘以及转化程度测量等研究设想。     

Health risk aversion,health risk affinity,and socio-economic position in the USA: The demographics of multiple risk

Understanding the distribution of behavioural risk factors in the population can improve health promotion. This article reports on a research project which analysed the distribution of numbers of behavioural risk factors among US adults, by race/Hispanic origin, sex, and age. Income, education, and region were examined as potential confounders in observed patterns. The B ehavioral Risk Factor Surveillance System (BRFSS) data for 1993 were used to assess the distribution of numbers of risk factors, i.e. smoking, heavy drinking, overweight, inadequate seatbelt use, Papanicolaou (pap) smear screening, mammography, colorectal screening, and influenza and pneumonia vaccination. Two hypotheses were examined: (1) given the distribution of each risk factor in the US population by age and sex, prevalences both of low and of high numbers of risk behaviours (but not of moderate numbers of risk behaviours) are greater than expected within each race/Hispanic origin-sex-age group; and (2) differences in socio-economic position among these groups account for the differences between observed and expected prevalences of numbers of risk factors. The second hypothesis was assessed both graphically by adjustment for income and education, and by multiple linear regression. The research found higher than expected prevalences of both low and high numbers of risk factors among whites and, possibly, among Hispanics. Among Asians prevalences were less than expected with greater numbers of risk factors. Among blacks and American Indians prevalences were lower than expected for low numbers of risk factors and were greater than expected with greater numbers of risk factors. Adjustment for income or education reduced differences between observed and expected prevalences. It appears that risk aversion and risk affinity vary substantially by race/Hispanic origin and are only partially explained by socio-economic position. Exploration of the causes of high and low risk behaviour may improve risk behaviour interventions.     

Health technology assessment: decentralized and fragmented in the US compared to other countries

This paper presents the results of the first comprehensive international survey to catalogue health technology assessment (HTA) activities. By 1995, there were formal HTA programs in 24 countries established mostly in the late 1980s and early 1990s. European countries generally have one or two federal or provincial HTA programs each, Canada has an extensive network of federal and regional organizations coordinated by a central body and the US has 53 HTA organizations, the vast majority of which are in the private sector. While the commitment of the US government to HTA has been erratic, the private sector has been witness to an expansion of HTA activities by insurance companies, hospitals, medical/device manufacturers, consulting firms and health professional societies. In contrast to other developed countries, the current state of technology assessment in the US is decentralized, fragmented and duplicative. We conclude by discussing the importance of a US HTA agency at the national level.     

粮食中微量元素的健康风险评价

采用湿法消解对市售面粉和大米进行处理,应用原子吸收分光光度计和流动注射氢化物发生器测定铜、锌、铁、锰、铅和砷6种重金属含量,应用健康风险评价模型对粮食中重金属可能引起的健康风险进行定量评价,结果表明金属砷和锌所引起的综合健康风险水平较高。     

健康管理与可控的健康危险因素

健康管理指一种对个人或人群的健康危险因素进行全面监管的过程。本文对健康管理的基本概念和步骤、健康危险因素评价方法及慢性病中的主要可控危险因素进行了综述,并探讨了危险因素的控制及对健康改善的影响。     

卫生技术评估优先顺序的确定

笔者介绍了医学技术评估过程中技术评估优先顺序的确定方法与步骤。其步骤①确定决策者关心的卫生问题与技术；②确定有助于决策者解决这些卫生问题（技术）的评估方法；③判断进行技术评估的成本与效益以决定技术评估的优先顺序；④将需要进行评估的技术先后顺序通告评估人员与使用这些技术的有关组织与人员，以及监督评估运动。     

德国卫生技术评估决策转化路径及方法探析

德国与我国有着相似医疗保障体系背景,并且已经形成以国家层面三大卫生技术评估(Health Technology Assessment,HTA)机构为主的严谨的HTA管理流程和高效的决策转化路径,是全球基于HTA进行卫生领域循证决策的典型代表。本文通过文献研究和实地调研,分析梳理了德国HTA应用及其决策转化的路径和方法,最终结合我国现阶段HTA决策转化面临的问题和挑战,有针对性地提出了几条促进我国HTA决策转化的启示性建议。     

卫生技术评估决策转化动力的量表开发

本研究首先通过前期研究回顾和理论分析,形成涵盖"证据影响力"、"机构支持力"、"渠道联接性"、"交流协作度"、"决策方推动力"五个维度的测量量表,并通过问卷调查,检验量表的信度和效度。结果显示量表的总体Cronbach'sα系数为0.904,除了"决策方推动力"维度外,其余四个维度的Cronbach'sα系数值均超过0.80;各维度的平均方差抽取量均超过0.50,且任意两个维度之间的相关系数的最大值为0.571(低于标准值0.85),各维度与其他维度的标准化相关系数均小于各维度平均方差抽取量的算术平方根,具有良好的信度、效度。     

我国卫生技术评估研究成果向决策转化的理论模型构建

在目前我国深入医药卫生体制改革的时代背景下,卫生技术评估领域开展了大量研究,如何顺利地实现相关研究成果向卫生政策的转化,成为亟待解决的重要问题。本文主要从知识转化的定义入手,回顾了在研究和实践中较多运用的三个知识转化理论模型,在此基础上提出了我国卫生技术评估研究成果向决策转化的理论模型,重点挖掘研究方和决策方影响转化的因素,并为促进研究成果的决策转化提出增进研究方和决策方之间的沟通交流、建立研究成果向决策转化的激励机制等建议。     

基于卫生技术评估构建医学人工智能技术临床应用评估路径的探讨

医学人工智能可以应用于疾病的预防、诊断和治疗等方面,以改善医疗服务的提供。卫生技术评估在国际上已广泛应用于新医药技术准入、医疗保险支付范围确定等方面。本文基于卫生技术评估,探讨构建我国医学人工智能临床应用评估路径,并提出了进一步发展的政策建议,为发展我国医学人工智能技术临床应用和卫生技术评估事业提供决策依据。     

卫生技术评估方法、应用与发展建议简

对卫生技术评估主要应用方法和评估程序、应用和传播进行了简要介绍,并针对我国卫生技术评估发展存在问题提出了发展建议。     

天津市冬季大气PM2.5中金属元素污染特征及健康风险评价

目的 了解天津市冬季大气PM2.5中金属元素的污染特征,并对人群进行健康风险评价。方法 采集市区、市郊和农村的3个社区2013年12月～2014年2月间的PM2.5样品,用称重法和电感耦合等离子体质谱法分别检测PM2.5的质量浓度和12种金属元素的浓度,并运用美国环保局推荐的模型进行健康风险评价。结果 市区、市郊和农村地区冬季PM2.5质量浓度变化范围为130.29～229.91 ug/m³,市区和市郊雾霾天高于非雾霾天,农村地区整体高于市区和市郊,五种金属元素的人群的非致癌危险度高低依次为Pb> Mn> Sb> Se> Hg,且对人群造成的健康风险均呈现出雾霾天高于非雾霾天,儿童高于成人的特点。市区,市郊和农村地区雾霾天和非雾霾天五种金属元素对人群的非致癌危险度均低于1,致癌金属元素Cr除市区和市郊非雾霾天外对人群的致癌危险度均在10^-5水平。结论 天津市大气PM2.5中金属元素污染较为严重,金属元素对人群不存在非致癌风险,As、Cd和Ni对人群的致癌危险度处于可接受水平,但Cr可能存在健康风险。     

Influence of a health technology assessment on the use of pediatric cochlear implantation in Kazakhstan

Objective

To evaluate the influence of a health technology assessment (HTA) on pediatric cochlear implantation (CI) in Kazakhstan and to provide a further perspective on the use of the technology in that country. Ideally, children should be implanted as young as possible, have adequate rehabilitation, and be integrated into the regular school system.

Social values and health priority setting in Australia: An analysis applied to the context of health technology assessment

ObjectiveTo describe the role of social values in priority setting related to health technology assessment processes and decision-making in Australia.ApproachThe processes and decision criteria of the Pharmaceutical and Medical Benefits Advisory Committees are described based on literature and policy sources, and analysed using a framework for identifying social values in priority-setting.FindingsTransparency and accountability of processes are apparent. Participation balances inclusiveness and effectiveness of decision-making, but presents an opportunity to enhance priority setting processes. Clinical and cost-effectiveness are important content considerations. Social values related to justice/equity are considered, without quantification of criteria weights for equity relative to other factors. HTA processes support solidarity through subsidising approved technologies for all Australians, whilst retaining autonomy by permitting non-subsidised technologies to be accessed privately, leading to possible tension between the values of solidarity, autonomy and equity.ConclusionsPriority setting related to health technology subsidy incorporates a range of inter-related social values in the processes and content of decision-making. Participation in decision-making could arguably be improved if a patient and public engagement policy were to be formulated alongside more widespread changes across processes to assess social values using approaches such as the Citizens’ Jury.     

英国NICE卫生技术评估研究决策转化机制及对我国的启示

英国国家卫生与服务优化研究院(NICE)被认为是利用卫生技术评估研究结果促进卫生循证决策的典范,在应对新医疗技术带来的过快卫生费用增长方面发挥了重要作用,其证据开发过程和研究成果向政策的转化过程同样也成为世界各国纷纷效仿的重要方面。本文介绍了NICE在英国卫生服务体系中的法定定位、开展卫生技术评估的类别、过程和政策转化机制,以期为促进国内卫生技术评估研究成果在循证卫生政策制定中的应用提供借鉴。     

深圳市饮用水中消毒副产物三卤甲烷的健康风险评价

目的 初步评价深圳市生活饮用水中三卤甲烷对人体健康产生的潜在危害.方法 于2010年1月-2011年12月,对深圳市13个市政水厂出厂水和部分末梢水中三卤甲烷(三氯甲烷、一氯二溴甲烷、二氯一溴甲烷、三溴甲烷)浓度进行检测,并对饮水途径所引起的健康风险做出初步评价.结果 深圳市饮用水中三卤甲烷及三氯甲烷、一氯二溴甲烷、二氯一溴甲烷和三溴甲烷浓度中位数分别为37.0、24.5、2.3、7.8、0.3 μg/L,致癌个人年风险分别为4.52×10-5、2.38×10-5、6.07×10-6、1.52×10-5、7.45×10-8/a,非致癌健康风险值个人年风险分别为9.32×10-2、7.68×10-2、3.61×10-3、1.23×10-2、4.71×10-4/a.三卤甲烷按风险大小排列为三氯甲烷＞二氯一溴甲烷＞一氯二溴甲烷＞三溴甲烷.结论 深圳市政出厂水中三卤甲烷对人体健康产生的潜在致癌个人年风险在美国环境保护署(USEPA)可以接受的限值(1.0×10-41.0× 10-6/a)之内,但接近国际辐射防护委员会(ICRP)推荐的最大可接受值(5.0×10-5/a);非致癌健康风险在USEPA可接受限值(HI＜1)之内.     

澳大利亚卫生技术评估的应用

卫生技术评估在澳大利亚的发展在全球是成功经验之一。卫生技术评估在药品福利计划中的应用从开始走向成熟,并逐渐应用到其他领域,目前整个过程历经约20年。澳大利亚的成功既有与其他国家的共性之处,也有其独特之处,并且目前仍在摸索不断前进。这也提示了中国需要将国际成功经历本土化,从而达到将卫生技术评估不断发展和深化的作用。