对我国成本效果阈值确定方法的思考

目的:对成本效果阈值现有的主要确定方法进行分析,寻找适合我国的阈值确定方法,为我国成本效果阈值的确定及应用奠定基础。方法:通过文献综述的方法,对目前主要的成本效果阈值确定方法进行回顾分析和归纳总结,在此基础上找出适合我国的成本效果阈值确定方法。结果:社会意愿支付法、阈值寻找者模式、人均GDP法均对我国成本效果阈值的确定有重要的借鉴意义。结论:建议以阈值寻找者模式为主、以人均GDP法(社会意愿支付法)为参考来确定我国的成本效果阈值,在寻找我国的成本效果阈值期间,可暂时先借鉴人均GDP法确定的经济性评价标准。     

社会意愿支付法确定成本效果阈值的介绍与思考

目的:介绍并分析社会意愿支付法的基本理论,为我国成本效果阈值的确定提供一定的方法论基础。方法:总结社会意愿支付法的优缺点,并与我国实际情况相结合,明确其对我国成本效果阈值确定的借鉴意义。结果:社会意愿支付法有体现民众意愿、随经济发展水平变化等优点、同时在理论角度、实践角度、制度角度以及方法本身角度等方面均存在一定的争议。结论:社会意愿支付法是最常用的成本效果阈值确定方法之一,在理论与实践等方面均有着独特的优势,运用该方法将会对我国的成本效果阈值科学确定起到积极的推进作用。     

成本-效果可支付曲线的理论与应用

目的:从理论和应用角度对一种新兴分析工具——成本-效果可支付曲线进行介绍,以期为我国药品决策研究与实践提供新思路。方法:通过分析成本-效果平面中成本-效果阈值线和可支付线的含义来引出和分析成本-效果可支付曲线,并借助已有实证研究对其含义进行分析和解释。结果:成本-效果可支付曲线结合了可支付线与阈值线二者提供的信息,是成本-效果阈值和预算限制的函数。结论:成本-效果可支付曲线可同时提供经济性与可支付性信息,在给定预算下随成本-效果阈值的变化而变化。     

我国药物经济学成本-效果阈值测算方法的选择与数据获取方法研究

目的：为我国药物经济学成本-效果阈值测算方法的选择和数据获取方法提供借鉴经验,以期我国在医保准入中设定合适的阈值参考范围,将真正具有经济性的药物纳入医保目录。方法：通过搜集整理现有成本-效果阈值测算方法的优劣势,结合国内外医保基金预算的灵活程度、数据获取的途径、 类型和测算方法的选择,试图寻找适合我国的阈值测算方法和数据获取方法。结果：我国的医保基金预算的灵活度不高且具有医保控费的压力,适宜选择机会成本法,但该方法数据获取难度较大,为提高该方法测算结果的可靠性,英国还通过ICD-10代码对疾病进行分类获取数据,在当前数据获取难度较大的情况下,有操作性较强的意愿支付法或人均国内生产总值（Gross Domestic Product,GDP）法可供选择。结论：我国适宜选择机会成本法,在当前数据获取难度较大的情况下,建议选择意愿支付法或人均 GDP法测得阈值作为参考。     

从净收益视角探讨成本-效果阈值的意义

目的:旨在从净收益法视角出发,明确成本-效果阈值在药物经济学中的重要意义。方法:分类介绍净收益法的4种情况,从理论方法层面分析4种情况下成本-效果阈值与净收益法的内在联系。结果:净收益法4种情况中的任何一种都要受到成本-效果阈值的影响。结论:净收益法的4种情况均是成本-效果阈值的函数,成本-效果阈值的取值直接决定净收益计算结果。     

信息价值分析与成本效果阈值

本文介绍了信息价值分析,明确信息价值分析与成本效果阈值之间的关系,指出在我国医药领域引进信息价值分析的必要性,从而进一步论证确定成本效果阈值的理论与现实意义。本文另阐述了信息价值分析的含义、指标及方法,深入分析并举例说明其与成本效果阈值的关系。信息价值分析可视为对不确定性分析的深化,能够定量计算降低不确定性所带来的期望价值;成本效果阈值对信息价值分析意义重大,其取值对信息价值分析起着决定性作用。引进信息价值分析有助于提高行业整体效率。     

芩香清解口服液治疗儿童上呼吸道感染的药物经济学评价

目的：评价芩香清解口服液用于儿童上呼吸道感染的经济性。方法：基于一项随机、双盲对照的临床研究,计算2组方案的成本和健康产出,进行短期成本-效果分析。采用条件价值评估法开展问卷调查,收集患者的意愿支付阈值。对关键指标进行单因素敏感性分析。结果：芩香清解口服液联用利巴韦林注射液组相对利巴韦林组增量成本效果比为8.34元,小于支付意愿阈值15.0元,芩香清解口服液联用利巴韦林注射液具有经济性。结论：芩香清解口服液联合利巴韦林注射液用于儿童上呼吸道感染是疗效佳、经济、安全的治疗方案,值得临床推荐。     

贝复济治疗Ⅱ度烧伤的上市后药物经济学评价

目的：基于对贝复济治疗II度烧伤的成本-效果分析基础上,进行上市后的预算影响分析。方法：基于已完成的贝复济治疗Ⅱ度烧伤的临床Ⅲ期试验数据库,回顾性收集费用数据,然后进行成本-效果分析与预算影响分析。结果：贝复济组较对照组,可以缩短烧伤创面的愈合时间,平均为2.78天。预算影响分析则提示：贝复济治疗组每增加1个效果单位（愈合时间缩短1天）所花成本比对照组节约934.53元。结论：贝复济治疗II度烧伤是有效、安全、经济的,我们的研究结果将为卫生行政和医疗保险部门的决策提供科学依据。     

对药物经济学评价方法的思考

目的:为我国药物经济学评价方法的选择提供依据和参考。方法:追溯药物经济学评价方法之源,分析人们对药物经济学评价方法的现有认识及发展态势,比较药物经济学不同评价方法的利弊。结果与结论:无论从选择经济评价指标的应然追求来看,还是从药物经济学评价目的、学科特点对评价方法的客观要求来看,药物经济学评价方法和指标的选择应该首选经济评价领域的"共性"方法,即最小成本分析法及成本-效益分析法。在上述方法不适用的情况下,考虑使用突出体现药物经济学特点的"个性"指标效果或效用来转换计量收益。     

影响贴现率选择的关键要素:成本效果阈值

目的:明确成本效果阈值是成本与效果贴现率选择的关键性影响因素,为进一步完善我国的贴现率提供启示。方法:通过介绍贴现率计算的公式推导来分析成本效果阈值如何影响贴现率的选择。结果:当两个时期的成本效果阈值相同时,成本和效果应该使用相同的贴现率;当两个时期的成本效果阈值不同时,应对成本和效果分别选择不同的贴现率进行计算。结论:成本效果阈值是影响成本贴现率与结果贴现率是否同一的关键性因素。     

从不确定性分析视角看成本效果阈值的应用

目的介绍成本效果平面在不确定性分析中的作用,明确成本效果阈值λ对成本效果平面以及不确定性分析中成本效果可接受曲线、成本效果可接受边界等方法的意义。方法从成本效果平面、成本效果可接受曲线、成本效果可接受边界的基本原理出发,分析成本效果阈值在3种方法中的应用。结果与结论成本效果阈值的设定可以决定成本效果平面中经济性区域的联合密度分布,提高成本效果可接受曲线、成本效果可接受边界等不确定性分析方法的实用性,从而可以更好的为决策制定提供服务。     

Cost Analysis of the American College of Chest Physicians Guidelines for Deep Vein Thrombosis Prophylaxis in Patients Undergoing Orthopedic Arthroplastic Surgery

Guidelines for prophylaxis of deep vein thrombosis secondary to orthopedic surgery have been developed. In selecting a specific drug for formulary inclusion, it is ideal for an individual institution to determine the cost of therapy, as well as the frequency of adverse events and the cost of treating them for each agent undergoing consideration. Cost-effectiveness analysis using incremental cost-effectiveness ratios and sensitivity analyses are useful for determining which drug may be most cost effective.     

Information created to evade reality (ICER): things we should not look to for answers

Cost-effectiveness analysis has been advocated in the health economics methods literature and adopted in a growing number of jurisdictions as an evidence base for decision makers charged with maximising health gains from available resources. This paper critically appraises the information generated by cost-effectiveness analysis, in particular the incremental cost-effectiveness ratio (ICER). It is shown that this ratio is used as comparative information on what are non-comparable options and hence evades the reality of the decision-maker's problem. The theoretical basis for the ICER approach is the simplification of theoretical assumptions that have no relevance to the decision maker's context. Although alternative, well established methods can be used for addressing the decision maker's problem, faced with the increasing evidence of the theoretical and empirical failures of the cost-effectiveness approach, some proponents of the approach now propose changing the research question to suit the approach as opposed to adopting a more appropriate method for the prevailing and continuing problem. As long as decision makers are concerned with making the best use of available healthcare resources, cost-effectiveness analysis and the ICER should not be where we look for answers.     

Median-based incremental cost-effectiveness ratios with censored data

Cost-effectiveness is an essential part of treatment evaluation, in addition to effectiveness. In the cost-effectiveness analysis, a measure called the incremental cost-effectiveness ratio (ICER) is widely utilized, and the mean cost and the mean (quality-adjusted) life years have served as norms to summarize cost and effectiveness for a study population. Recently, the median-based ICER was proposed for complementary or sensitivity analysis purposes. In this article, we extend this method when some data are censored.     

The decision rules of cost-effectiveness analysis

It has become increasingly popular to carry out cost-effectiveness analyses in economic evaluations of healthcare programmes. Cost-effectiveness analysis is based on the maximisation of the health effects for a given amount of resources. However, many published studies fail to report the results of cost-effectiveness analysis in a way that is consistent with this underlying aim. The aim of this article is to demonstrate the decision rules of cost-effectiveness analysis in an easily accessible way for practitioners in the field. A hypothetical example is used to demonstrate the decision rules of cost-effectiveness analysis, and we also show how to estimate the appropriate incremental cost-effectiveness ratios and how to exclude dominated alternatives. It is then shown how fixed budgets or predetermined prices per effectiveness unit can be used as decision rules to maximise health effects and to determine which programmes to implement on the basis of incremental cost-effectiveness ratios. We hope that the article will contribute towards an increased understanding and application of the appropriate decision rules of cost-effectiveness analysis, so that the results of cost-effectiveness analyses can be interpreted meaningfully by decision makers.     

青霉素每日序贯给药与常规静滴疗法217例的成本-效果分析

目的:分析比较青霉素每日序贯给药与常规静滴疗法治疗呼吸道轻、中度感染的成本和效果,为临床青霉素静滴中的不合理用药提供新的改进方法。方法:选取需静滴给药的轻、中度呼吸道感染患者,随机分为序贯法治疗组(青霉素id. po.)和常规法治疗组(id.)进行试验,有效病例分别为112例、105例。采用直接成本的成本-效果分析法对试验结果进行分析,并对其间接成本和隐性成本作比较讨论。结果:两种方法的有效率分别为91·0%和94·3%(P>0.05)。序贯治疗组的成本效果比(2·04)小于常规治疗组(3·11),且在统计学上差异显著(P<0.05)。结论:青霉素每日序贯给药与常规静滴疗法治疗呼吸道轻、中度感染疗效相当,但在降低治疗的成本上具有优势。     

复方甘草甜素与还原型谷胱甘肽治疗慢性乙型肝炎的成本-效果分析

目的 　对复方甘草甜素和还原型谷胱甘肽治疗慢性乙型肝炎进行经济学评价 ,为临床提供最佳用药方案。 方法 　采用随机分组对照进行临床实验观察 ,分析比较复方甘草甜素与还原型谷胱城肽的治疗成本和治疗效果。 结果 　复方甘草素和干扰素α-1b治疗慢性乙型肝炎的总有效率分别为 70 .67%和 66.67% ( P>0 .0 5 ) ;成本 -效果比分别为 46.42和 76.44 ( P<0 .0 5 ) ;经敏感度分析所得的成本 -效果比分别为 3 9.45和64 .97。 结论 　复方甘草甜素与还原型谷胱甘肽均能有效治疗慢性乙型肝炎 ,但复方甘草甜素比还原型谷胱甘肽更经济 ,更符合药物经济学原则。     

Cost-Effectiveness Analysis: A Proposal of New Reporting Standards in Statistical Analysis

Cost-effectiveness analysis (CEA) is a method for evaluating the outcomes and costs of competing strategies designed to improve health, and has been applied to a variety of different scientific fields. Yet there are inherent complexities in cost estimation and CEA from statistical perspectives (e.g., skewness, bidimensionality, and censoring). The incremental cost-effectiveness ratio that represents the additional cost per unit of outcome gained by a new strategy has served as the most widely accepted methodology in the CEA. In this article, we call for expanded perspectives and reporting standards reflecting a more comprehensive analysis that can elucidate different aspects of available data. Specifically, we propose that mean- and median-based incremental cost-effectiveness ratios and average cost-effectiveness ratios be reported together, along with relevant summary and inferential statistics, as complementary measures for informed decision making.