成本--效用分析原则及方法初探

成本——效用分析是近20年来发展起来的一种卫生项目评价方法，是制定卫生政策的决策工具之一。在成本——效用分析中，通过比较项目获得每单位调整质量生命年(QALY)所消耗的成本，来对项目效率作出评价。本文介绍了成本——效用分析方法的原则与方法，以及在执行项目中需注意的问题。     

乌鲁木齐市2002～2009年结核病控制项目卫生经济学评价

目的分析评价乌鲁木齐市实施结核病控制项目的成本-效用成本-效果及社会效益和经济效益,为卫生资源投入与使用提供科学依据。方法收集2002～2009年结核病控制项目季报、年报及人口学资料,进行成本-效果、成本-效用、成本-效益分析。结果 8年间政府及相关国际组织投入经费667.8万元,共治愈病人3 362例,每发现并治疗一例患者费用为999.1元,挽回DALY 35 432年,共获得496个完整生命。减少新肺结核病人1 681～2 522例,间接避免了新发病例DALY损失17 716～26 579年。挽回GDP损失约23.48亿元,避免了因病造成的个人收入损失累计达7.26亿元。结论 8年来乌鲁木齐市结核病控制项目取得效果明显,为保障人民群众身体健康做出了积极贡献。     

两种剂型卡巴拉汀治疗阿尔茨海默病的成本-效用对比分析

目的:从我国医疗卫生系统角度出发,评价卡巴拉汀胶囊剂对比卡巴拉汀透皮贴剂治疗阿尔兹海默病的经济性。方法:构建马尔可夫模型,模拟患者终身的质量调整生命年和增量成本-效用比,并进行单因素敏感性分析和概率敏感性分析进一步检验模型结果的正确性和稳定性。结果:基础分析结果显示透皮贴剂组患者比胶囊剂组多获得1.10个QALYs的同时,少花费79 758.79元,增量成本-效用比为-72 507.99元/QALY,为绝对优势方案;单因素敏感性分析显示对模型最敏感的3个因素分别是胶囊剂每周期成本、贴现率及重度状态效用值;概率敏感性分析显示无论意愿支付值多大,透皮贴剂组始终更具成本效用优势。结论:卡巴拉汀透皮贴剂相对于卡巴拉汀胶囊剂成本更低,效用更高,是更具经济性的优势方案。     

脑卒中常见康复疗法的成本-效果和成本-效用分析

目的 探究脑卒中常见康复疗法的经济性。方法 收集患者基本信息、治疗成本、康复治疗前后MBI值及HUI2量表评分，进行成本-效果和成本-效用分析。结果 比较各组康复治疗前和治疗后的MBI均值，差异有统计学意义（P＜0.05），康复治疗后4组获得的MBI值分别是18.44、12.54、11.32、10.09；4组的成本-效果比是1 556.52、1 655.99、1 925.84、1 385.37；比较各组康复治疗前和治疗后的效用值，差异有统计学意义（P＜0.05），康复治疗前4组效用值分别是0.55、0.52、0.45、0.43，康复治疗后的效用值分别是0.78、0.76、0.71、0.71，4组的成本-效用比是4 842.82、5 231.58、6 176.69、5 307.54。结论 脑卒中患者每获得一个MBI值和一个QALYs，康复治疗费用低于贵州省人均GDP，根据脑卒中患者康复治疗后日常生活能力的恢复和生命质量的改善来看，患者康复治疗的花费是可接受的且认为是值得的。     

成本效用分析方法介绍

成本效用分析是项目经济评价的一种方法。在成本效用分析中，通过比较项目投入成本量和项目获得的质量调整生命年来衡量项目的效率。成本效用分析已广泛应用在卫生保健项目的经济评价中。     

哈尔滨市农村癫痫患者卫生经济学评价研究

目的 通过对农村癫痫患者的卫生经济学评估，确定癫痫患者管理模式的投入与产出，优化卫生资源配置，为卫生政策的制定提供理论依据。方法 将236例参与农村癫痫防治管理项目初筛，被诊断为惊厥型癫痫患者分为2组，其中项目组149例，对照组87例。项目组采用单纯苯巴比妥药物治疗，对照组为已确诊但未加入项目组治疗的患者。随访6个月，以有效率和QALYs作为效果和效用的评价指标，对癫痫患者的成本-效果和成本-效用进行卫生经济学评价。结果 项目组和对照组在治疗效果上具有统计学差异（χ2 = 20.71，P＜0.05），项目组有效治疗1例癫痫患者所花费的成本为57.82元，而对照组的成本为116.89元，为项目组的2.04倍；获得每1个分值生命质量，项目组需花费1 080.34元，而对照组则需花费1 806.09元。相对于对照组，项目组每增加1个QALY的增量成本为-10386.43元。结论 使用苯巴比妥药物治疗惊厥型癫痫患者疗效具有优势，且成本-效用优势明显，适合在农村地区广泛推广和应用。     

密切接触者人群队列肺结核发现策略的成本-效用分析

目的:对密切接触者主动筛查策略进行成本-效用分析,为肺结核的早期发现与防治策略提供科学依据。方法:建立密切接触者筛查策略的决策树-Markov模型,比较病例被动筛查策略与病例主动筛查策略的成本-效用。结果:与病例被动筛查策略相比,采用终身一次的病例主动筛查策略、终身两次不连续的病例主动筛查策略、每年一次的病例主动筛查策略的潜伏感染发生率、结核病发病率、死亡率均依次降低,并且每增加1 QALY的花费分别为8 973.3元、8 995.0元、10 801.2元,均低于WTP阈值标准,3种病例主动筛查策略均具有成本-效用优势。结论:对密切接触者连续开展主动筛查具有较高的成本-效用价值,是一项经济有效的公共卫生干预措施。     

两种非甾体抗炎药物方案治疗类风湿关节炎的成本--效用分析

目的 :评价两种非甾体抗炎药物的疗效和经济性 ,探索成本 -效用分析方法的应用。方法 :对 1 0 6例类风湿关节炎 (RA)患者随机分两组 (A:奥湿克组 ,B:扶他林组 ) ,使用自编 RA生命质量量表对患者进行评价 ,提取评分法效用值 ,进行成本效用分析 (cost- utility analysis,CUA)。结果 :B组的成本效用比 (CUR)为 52 92 7.0 8元 / QALY,A组的 CUR值 67838.30元 / QALY,敏感度分析得到一致结果 ,增量成本效用分析表明每增加 1 QALY,A组至少需追加花费1 9980 5.1 4元 ,故认为 B方案经济、有效。结论 :对于 RA、癌症等慢性病患者采用 CUA分析 ,能够全面评价患者生命质量 ,保证卫生资源的合理利用     

山东省高密县防氟改水工程成本效用分析研究

成本效用分析(Cost Vtility Analysis,CVA),是国外近二十年发展起来的一种卫生项目经济评价方法,是制定卫生政策的决策工具之一。本研究旨在将成本效用分析方法用于防氟改工作评价,通过对山东省高密县4种不同类型防氟改水工程的经济效益进行分析和评价,对该方法的应用进行探讨。     

成本-效果分析和成本-效用分析研究进展及应用

成本-效果分析(Cost-effectiveness Analysis,CEA)和成本-效用分析(Cost-utility Analysis,CUA)是评价医疗服务效果和效用的先进技术,为资源配置和优选项目的确定提供了强有力的科学证据。对CEA和CUA全面深入地加以理解和把握,将有力地提升管理水平和科学决策。本文综述CEA和CUA的理论基础、分析方法、研究意义和最新成果。     

成本效果阈值理论介绍：单位、定义与特征

目前,成本效果阈值的单位、定义与特征存在着诸多争议,经过分析比较将这些争议与不同详细列出,并简要分析其优缺点,为我国成本效果阈值的单位、定义与特征的确立奠定基础。     

An opportunity cost approach to sample size calculation in cost-effectiveness analysis

The inclusion of economic evaluations as part of clinical trials has led to concerns about the adequacy of trial sample size to support such analysis. The analytical tool of cost-effectiveness analysis is the incremental cost-effectiveness ratio (ICER), which is compared with a threshold value (lambda) as a method to determine the efficiency of a health-care intervention. Accordingly, many of the methods suggested to calculating the sample size requirements for the economic component of clinical trials are based on the properties of the ICER. However, use of the ICER and a threshold value as a basis for determining efficiency has been shown to be inconsistent with the economic concept of opportunity cost. As a result, the validity of the ICER-based approaches to sample size calculations can be challenged. Alternative methods for determining improvements in efficiency have been presented in the literature that does not depend upon ICER values. In this paper, we develop an opportunity cost approach to calculating sample size for economic evaluations alongside clinical trials, and illustrate the approach using a numerical example. We compare the sample size requirement of the opportunity cost method with the ICER threshold method. In general, either method may yield the larger required sample size. However, the opportunity cost approach, although simple to use, has additional data requirements. We believe that the additional data requirements represent a small price to pay for being able to perform an analysis consistent with both concept of opportunity cost and the problem faced by decision makers.     

Incremental cost-effectiveness ratios (ICERs): the silence of the lambda

Despite the central role of the threshold incremental cost-effectiveness ratio (ICER), or lambda (lambda), in the methods and application of cost-effective analysis (CEA), little attention has been given to the determining the value of lambda. In this paper we consider 'what explains the silence of the lambda'? The concept of the threshold ICER is critically appraised. We show that there is 'silence of the lambda' with respect to justification of the value of ICER thresholds, their use in decision-making and their relationship to the opportunity cost of marginal resources. Moreover, the 'sound of silence' extends to both 'automatic cut-off' and more sophisticated approaches to the use of lambda in determining recommendations about health care programs. We argue that the threshold value provides no useful information for determining the efficiency of using available resources to support new health care programs. On the contrary, the threshold approach has lead to decisions that resulted in increased expenditures on health care programs and concerns about the sustainability of public funding for health care programs without any evidence of increases in total health gains. To improve efficiency in resource allocation, decision-makers need information about the opportunity costs of programs.     

罗替高汀与普拉克索治疗帕金森病的成本效果分析

目的:分析罗替高汀与普拉克索(常释剂/缓释剂)治疗帕金森病的成本效果.方法:基于卫生服务体系的角度,根据临床指南中的标准临床路径及H&Y分级,采用动态Markov模型,模拟患者终生的直接医疗成本和质量调整生命年.结果:在治疗帕金森病中,与普拉克索常释剂相比,罗替高汀提高0.062 9个质量调整生命年,费用提高70 36...     

Local health care expenditure plans and their opportunity costs

BackgroundIn the UK, approval decisions by Health Technology Assessment bodies are made using a cost per quality-adjusted life year (QALY) threshold, the value of which is based on little empirical evidence. We test the feasibility of estimating the “true” value of the threshold in NHS Scotland using information on marginal services (those planned to receive significant (dis)investment). We also explore how the NHS makes spending decisions and the role of cost per QALY evidence in this process.Data and methodsWe identify marginal services using NHS Board-level responses to the 2012/13 Budget Scrutiny issued by the Scottish Government, supplemented with information on prioritisation processes derived from interviews with Finance Directors. We search the literature for cost-effectiveness evidence relating to marginal services.ResultsThe cost-effectiveness estimates of marginal services vary hugely and thus it was not possible to obtain a reliable estimate of the threshold. This is unsurprising given the finding that cost-effectiveness evidence is rarely used to justify expenditure plans, which are driven by a range of other factors.Discussion and conclusionsOur results highlight the differences in objectives between HTA bodies and local health service decision makers. We also demonstrate that, even if it were desirable, the use of cost-effectiveness evidence at local level would be highly challenging without extensive investment in health economics resources.     

Informing Global Cost-Effectiveness Thresholds Using Country Investment Decisions: Human Papillomavirus Vaccine Introductions in 2006-2018

ObjectivesCost-effectiveness analysis can guide decision making about health interventions, but the appropriate cost-effectiveness threshold to use is unclear in most countries. The World Health Organization (WHO) recommends vaccinating girls 9 to 14 years against human papillomavirus (HPV), but over half the world’s countries have not introduced it. This study aimed to investigate whether country-level decisions about HPV vaccine introduction are consistent with a particular cost-effectiveness threshold, and to estimate what that threshold may be.MethodsThe cost-effectiveness of vaccinating 12-year-old girls was estimated in 179 countries using the Papillomavirus Rapid Interface for Modelling and Economics (PRIME) model, together with vaccine price data from World Health Organization’s Market Information for Access to Vaccines database. In each year from 2006 to 2018, countries were categorized based on (1) whether they had introduced HPV vaccination, and (2) whether the incremental cost-effectiveness ratio for HPV vaccine introduction fell below a certain cost-effectiveness threshold.ResultsA cost-effectiveness threshold of 60% to 65% of GDP per capita has the best ability to discriminate countries that introduced vaccination, with a diagnostic odds ratio of about 7. For low-income countries the optimal threshold was lower, at 30% to 40% of GDP per capita.ConclusionsA cost-effectiveness threshold has some ability to discriminate between HPV vaccine introducer and non-introducer countries, although the average threshold is below the widely used threshold of 1 GDP per capita. These results help explain the current pattern of HPV vaccine use globally. They also inform the extent to which cost-effectiveness thresholds proposed in the literature reflect countries’ actual investment decisions.     

A mathematical model for the determination of the optimum value of the treatment threshold for a continuous risk factor

Hypercholesterolemia or hypertension are continuous risk factors for coronary heart disease. When a preventive action is carried out against such a risk factor, it is necessary to specify a risk factor level value, named the treatment threshold, above which a subject should be treated. But a non-arbitrary determination of this threshold value is impossible from the epidemiological data. A method for the non-arbitrary determination of the treatment threshold value is presented, based upon mathematical modelling of the clinical and economics consequences of the prevention policy in the whole population. In a cost-effectiveness approach, the model was used to estimate the cost per coronary event prevented according to the threshold value for blood cholesterol. It was found that a minimum in this outcome proposed as the optimum treatment threshold. It is possible, from a public health point of view, to determine an optimum, non-arbitrary treatment threshold value in the prevention of coronary heart disease with cholesterol-lowering interventions. The model proposed here could be useful in decision making processes.     

Budget allocation and the revealed social rate of time preference for health

Appropriate decisions based on cost-effectiveness evaluations of health-care technologies depend upon the cost-effectiveness threshold and its rate of growth as well as some social rate of time preference for health. A more traditional approach to this problem is outlined before a social decision-making approach is developed, which demonstrates that social time preference for health is revealed through the budget allocations made by a socially legitimate higher authority. The relationship between the social time preference rate for health, the growth rate of the cost-effectiveness threshold and the rate at which the higher authority can borrow or invest is then examined. We establish that the social time preference rate for health is implied by the budget allocation and the health production functions in each period. As such, the social time preference rate for health depends not on the social time preference rate for consumption or growth in the consumption value of health but on growth in the cost-effectiveness threshold and the rate at which the higher authority can save or borrow between periods. The implications for discounting and the policies of bodies such as NICE are then discussed.     

Inquiry into the Relationship between Equity Weights and the Value of the QALY

BackgroundA commonly held view of the decision rule in economic evaluations in health care is that the final incremental cost-effectiveness ratio needs to be judged against some threshold, which is equal for all quality-adjusted life-year (QALY) gains. This reflects the assumption that “a QALY is a QALY” no matter who receives it, or the equity notion that all QALY gains are equally valuable, regardless of the context in which they are realized. If such an assumption does not adequately reflect the distributional concerns in society, however, different thresholds could be used for different QALY gains, whose relative values can be seen as “equity weights.”AimOur aim was to explore the relationship between equity or distributional concerns and the social value of QALYs within the health economics literature. In light of the empirical interest in equity-related concerns as well as the nature and height of the incremental cost-effectiveness ratio threshold, this study investigates the “common ground” between the two streams of literature and considers how the empirical literature estimating the incremental cost-effectiveness ratio threshold treats existing distributional considerations.     

固体径迹法测量氡及子体的判断阈和探测限

目的 研究利用固体径迹技术测量氡及子体的瓶颈技术问题,探讨本底氡对个人监测可靠性的影响及有效控制方法。方法 依据统计学规律,参考相关文献,结合剂量学分析,推导固体径迹技术测量氡及子体的判断阈和探测下限,进行辐射剂量估算。结果 利用应用举例方式,给出了具体实例的判断阈和探测下限。结论 发生β错误的概率不仅与判断阈L_C有关,而且与净径迹计数有关。净径迹计数值越大,β错误的概率就越小,可给出最小可探测径迹计数,估计最小可探测氡浓度,提高了氡个人剂量监测的可靠性。