卫生技术评估指标探讨

从卫生技术应用目的和评估内容两个方面入手探讨卫生技术评估指标,并提出了指标建立时需要注意的问题。     

卫生技术评估

一、卫生技术评估是指对卫生技术的技术特性、临床安全性、有效性 (效能、效果和生存质量 )、经济学特性 (成本—效果、成本—效益、成本—效用 )和社会适应性 (社会、法律、伦理、政治 )进行系统全面的评价 ,为各层次的有关决策者提供合理选择卫生技术的科学信息和决策依据 ,对卫生技术开发、应用、推广与淘汰实行政策干预 ,从而合理配置卫生资源 ,提高有限卫生资源的利用质量和效率。二、科学技术成果在医学领域的广泛应用 ,促进了医疗技术水平的提高 ,为人类生存条件的改善和健康质量的提高作出了巨大贡献。但技术的应用在产生积极后果的…     

卫生技术评估的特点

卫生部门是高新技术研究应用程度很高的一个部门。近十多年来,我国卫生事业在改革开放的大好形势下发展很快,医学科技水平有了很大的提高。随着越来越多种类的高新卫生技术在卫生领域的广泛开发应用,一方面大大促进了我国医疗卫生技术水平的提高,为更好地满足人民卫生保健需求作出了巨大的贡献,另一方面也同科学技术在其他领域应用的情况一样,同样导致了一些负面影响。笔者认为,对于卫生技术的负面影响,现在是到引起足够重视,研究采取相应对策的时候了。     

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。     

关于医疗服务质量与技术水平评估指标导向作用的思考

医疗卫生机构的服务质量与技术水平评估指标具有技术和社会价值导向作用。该文从当前卫生改革目标角度,阐述了服务质量与技术水平评估指标应与国家卫生公共政策相一致,应建立科学开放的评估体系,以适应社会经济发展和成为推进改革的导向。     

卫生监督监测指标的综合评估

《中国卫生监督统计报告工作手册》中，给学校卫生制定了卫统3b－1、卫统3d－2、卫统3b－3等3份报表，合学校卫生状况、学生健康状况、疾病防治情况和病伤缺深情况等方面指标。然而，如何利用诸多指标来综合评估一个地区或一个单位的学技卫生工作，是摆在学校卫生管理者面前的一个现实问题。学校卫生监督监测指标的综合评估，是多因素、多水平的分析命题，采用经典数学和卫生统计方法，计算复杂繁冗，现可采用系统工程中多目标分析的层次分析法（简称AHP法）进行综合评估，则显得简捷而实用，现以实例报告综合评估步骤。1确定评估因素以体…     

泰国卫生技术评估机制建设现状及启示

文章介绍了泰国卫生技术评估的发展历程、具体应用、机构建设,以及运行机制和规范化评估工具。启示我国在国家级HTA机构发展良好的基础上,应鼓励各地区设立和发展HTA机构;建立完整规范的决策转化机制;逐步建设形成适合我国的卫生技术评估规范化工具;建设HTA数据共享平台,以不断提升我国卫生技术评估能力。     

生殖健康指标的探讨

通过参阅许多国际组织有关文献，并结合中国实际情况，论述了生殖健康的最主要目的、基本概念与主要范畴。而且着重阐述衡量生殖健康水平的１２项概念性指标和六大方面（共３７项）可操作性指标。另外还从４个方面探讨了建立生殖健康指标的意义。     

卫生部卫生技术评估重点实验室暨复旦大学医学技术评估研究中心

复旦大学医学技术评估研究中心是在卫生部直接领导下成立的我国第一家卫生技术评估机构,成立于1994年1月,由陈洁教授担任主任。2004年5月,卫生部批文同意复旦大学在该中心基础上组建卫生部卫生技术评估重点实验室。该重点实验室主任为陈洁教授,学术委员会主任为上海社会科学院常务副院长左学金教授。     

Evaluation of Diversity of Clinical Trials Informing Health Technology Assessments in the United States: A 5-Year Analysis of Institute for Clinical and Economic Review Assessments

ObjectivesThis study aimed to evaluate the diversity of clinical trials informing assessments conducted by the Institute for Clinical and Economic Review.MethodsThis was a cross-sectional study of pivotal trials included in completed Institute for Clinical and Economic Review assessments over 5 years (2017-2021). Representation of racial/ethnic minority groups, females, and older adults was compared with the disease-specific and US population, using a relative representation cutoff of 0.8 for adequate representation.ResultsA total of 208 trials, evaluating 112 interventions for 31 unique conditions, were examined. Race/ethnicity data were inconsistently reported. The median participant-to-disease representative ratio (PDRR) for Blacks/African Americans (0.43 [interquartile range (IQR) 0.24-0.75]), American Indians/Alaska Natives (0.37 [IQR 0.09-0.77]), and Hispanics/Latinos (0.79 [IQR 0.30-1.22]) were below the adequate representation cutoff. In contrast, Whites (1.06 [IQR 0.92-1.2]), Asians (1.71 [IQR 0.50-3.75]), and Native Hawaiian/Other Pacific Islanders (1.61 [IQR 0.77-2.81]) were adequately represented. Findings were similar when compared with the US Census, except for Native Hawaiian/Pacific Islanders, which was substantially worse. Relative to all trials, a higher proportion of US-based trials adequately represented Blacks/African Americans (61% vs 23%, P < .0001) and Hispanics/Latinos (68% vs 50%; P = .047), but a lower proportion adequately represented Asians (15% vs 67%, P < .0001). Females were adequately represented in 74% of trials (PDRR: 1.02 [IQR 0.79-1.14]). Nevertheless, older adults were adequately represented in only 20% of trials (PDRR: 0.30 [IQR 0.13-0.64]).ConclusionsThe representation of racial/ethnic minorities and older adults was inadequate. Efforts are needed to enhance the diversity of clinical trials. Standardized and transparent evaluation of trial diversity should be part of the health technology assessment process.     

Reviewing the Evidence to Inform the Population of Cost-Effectiveness Models within Health Technology Assessments

ObjectivesHealth technology assessments (HTAs) typically require the development of a cost-effectiveness model, which necessitates the identification, selection, and use of other types of information beyond clinical effectiveness evidence to populate the model parameters. The reviewing activity associated with model development should be transparent and reproducible but can result in a tension between being both timely and systematic. Little procedural guidance exists in this area. The purpose of this article was to provide guidance, informed by focus groups, on what might constitute a systematic and transparent approach to reviewing information to populate model parameters.MethodsA focus group series was held with HTA experts in the United Kingdom including systematic reviewers, information specialists, and health economic modelers to explore these issues. Framework analysis was used to analyze the qualitative data elicited during focus groups.ResultsSuggestions included the use of rapid reviewing methods and the need to consider the trade-off between relevance and quality. The need for transparency in the reporting of review methods was emphasized. It was suggested that additional attention should be given to the reporting of parameters deemed to be more important to the model or where the preferred decision regarding the choice of evidence is equivocal.DiscussionThese recommendations form part of a Technical Support Document produced for the National Institute for Health and Clinical Excellence Decision Support Unit in the United Kingdom. It is intended that these recommendations will help to ensure a more systematic, transparent, and reproducible process for the review of model parameters within HTA.     

Scientific Evidence in Health Technology Assessment Reports: An In-Depth Analysis of European Assessments on High-Risk Medical Devices

Background

The aim of this study was to examine the scientific evidence on clinical effectiveness and safety used in health technology assessments (HTAs) of high-risk medical devices (MDs) in Europe.

广东省基层适宜卫生技术使用现状及筛选评价探讨

通过对广东省不同经济发展水平地区的基层医疗机构进行调查,了解其治疗常见病、多发病的卫生技术使用情况,探讨技术使用环境与卫生技术使用之间的关系,为开展适宜卫生技术遴选、推广和评估提供科学依据.     

A Systematic Review of Health Technology Assessments of Chimeric Antigen Receptor T-Cell Therapies in Young Compared With Older Patients

ObjectivesThe objective of this review was to identify sources of variability in cost-effectiveness analyses of chimeric antigen receptor T-cell (CAR-T) therapies, tisagenlecleucel and axicabtagene ciloleucel, evaluated by health technology assessment (HTA) agencies, focusing on young compared with older patients.MethodsHTA evaluations in pediatric acute lymphoblastic leukemia (ALL) and adult diffuse large B-cell lymphoma (DLBCL) were included from Australia, Canada, England, Norway, and the United States. Key clinical evidence, economic approach, and outcomes (costs, quality-adjusted life-years [QALYs] and incremental cost-effectiveness ratios) were summarized.ResultsFourteen HTA evaluations were identified (5 ALL, 9 DLBCL [4 tisagenlecleucel, 5 axicabtagene]). Analyses were naive comparisons of prospective single-arm studies for the CAR-Ts with retrospective cohort studies for the comparators. Key clinical evidence and economic model approaches were generally consistent by CAR-T and indication, although outcomes varied. Notably, incremental QALYs varied substantially in ALL (3.67-10.6 QALYs gained), whereas variation in DLBCL was less (1.21-1.97 [tisagenlecleucel], 1.97-3.40 [axicabtagene]). Discounting of costs and outcomes varied, with the highest QALYs generated for tisagenlecleucel in ALL (10.95) associated with the lowest discount rate (1.5%) and vice versa (4.97 QALYs; 5% discount rate). The approach to extrapolation of overall survival data varied, even where the same empirical data were used.ConclusionModeled, long-term treatment benefit in young patients may be associated with greater uncertainty compared with adults because of potential life-long benefits with cell and gene therapies. This reflects the methodological challenges identified by HTA agencies associated with single-arm, short-term studies.     

医学技术成果卫勤转化价值评估模型构建

军队作为一个特殊的群体,在卫勤保障活动中需要充分发挥医学科技的支撑作用,实现医学技术成果向军队转化,形成现实的卫勤保障能力.通过对医学技术成果进行转化价值评估,促进科技资源合理配置,提升成果转化效率.利用文献资料调查、政策分析和专家咨询等方法,界定医技成果卫勤转化价值概念,建立评估指标体系,利用层次分析法,计算得出各指标权重,建立基于转化动力的卫勤转化价值评估模型.通过对三种止血器材和三种骨折临时固定方案的实证研究,证明卫勤转化价值评估方法有效.     

Index System of Health Services Quality Evaluation on Township Health Centers

THERE IS ABOUT 80% of total population in ruralChina. Rural health care is an important content ofbuilding socialism new villages, and is a big thing tosafeguard peasants’ health and protect agricultureproductivity, invigorate rural economy and maintainsocial stability. So, rural health acre is a pivot ofChina’s health development. In 1997, the policy “tostrengthen rural health organization constructionand to perfect three-level health services systemincluding the county, the town and the village” wasdefini...     

浅议医疗器械技术评估

本文描述了卫生技术评估的基本概念、重要作用及开展现状,借鉴国外经验,提出了大力推动我国医疗器械技术评估工作的建议。     

卫生技术评估的基本步骤

该文结合国际经验和目前国内开展卫生技术评估研究工作的实践 ,简要介绍了卫生技术评估的基本步骤 ,以促进评估工作在我国进一步系统化和科学化 ,更好地为合理利用卫生资源服务。