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。     

经济学评价中支付意愿的测量方法

所谓经济学评价就是比较能够改善健康状况的各种备选方案的投入与产出，通常分为成本效益分析、成本效果分析和成本效用分析三种评价方法。在成本效果分析和成本效用分析中，产出指标用非货币形式表示，但这并不能说明某项措施带来的效益是否大于成本，解决这个问题的办法就是把产出用货币来表示，即测量获得健康状况改善的支付意愿。在成本效益分析中，成本和效益均用货币单位表示。一个卫生项目的效益是用受益于该项目的个体支付意     

医学计量的经济学分析概论

概述医学计量的成本构成,医学计量的机会成本,成本——收益(直接成本与收益,间接成本,医学计量的经济评价方法,成本效果分析,成本效用分析,成本效益分析)。     

成本效益与成本效果分析及在计划生育上的应用

成本——效益与成本——效果分析的历史顾回成本——效益与成本——效果分析原理的提出已有好几个世纪,这些原理在卫生保健上的应用也至少有三百年的历史。十七世纪中叶,一个有名的英国医生Richard Petty提出要增加医学投资,他认为,被救活的这个人的价值远远超过抢救这个人的成本。在美国,一个世纪以前Lemuel Shattack 在一次著名的报告中也提出类似的观点,他运用成本——效益的原理证明他在波士顿提出的卫生改革建议是正确的。     

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。     

武汉市中盖项目HIV阳性发现的卫生经济学分析

目的:分析武汉市中盖项目在HIV阳性发现方面的经济学效率,为项目评估与政策制定提供科学依据。方法:在测量2008—2011年HIV阳性发现的成本、效果、效用、效益的基础上进行卫生经济学分析,并以敏感度分析测量指标的变化范围。结果:中盖项目避免1例感染的成本是858.35元,每挽回1个DALY的成本为39.86元,均低于印度、坦桑尼亚和肯尼亚艾滋病自愿咨询检测(VCT)的效果和效用成本;项目每投入1元钱可挽回GDP损失1 713.26元、可挽回个人收入595.12元。结论:项目在HIV阳性发现方面具有一定的成本-效果、成本-效用、成本-效益等经济学价值。     

价值判断与成本-效用阈值探索

成本-效用阈值是成本-效用分析中判断卫生干预项目经济性与否的不可或缺的外生经济性判断指标。结合价值哲学中价值判断相关理论,认为成本-效用阈值来源于资源分配决策的需求,是对卫生项目进行经济价值判断的基准,受价值判断主体需求、价值判断目标、价值判断标准以及价值判断范畴等价值判断环境的影响,具有可变性,在实际应用中体现了主观性和客观性的辨证统一。     

永州市世界银行贷款结核病控制项目卫生经济学评价

目的从卫生经济学角度分析评价永州市结核病控制项目的经济学效应，探索该项目的合理性与收益性。方法采用卫生经济学理论与方法对结控项目的成本／效果，成本／效用，成本／效益三方面进行分析评价。结果该项目实施九年，发现活动性肺结核病人24117例，治愈21780例（含新发涂阴），挽回143829个伤残调整生命年（DALY），挽回国民生产总值（GDP）143．5万元，挽回病人个人损失2121．2万元，挽回疾病经济负担1694．9万元，挽回DALY。项目总产出4546．7万元。结论该项目投资风险小，可操作性强，经济效益显著，是非常值得借鉴和推广的疾病控制卫生项目。     

医院经营管理简明教程 第十五讲 医院经营效益分析方法

1 费用——效益分析法 对投入与产出或费用与成果进行量化分析的最严密的方法是“费用——效益分析”,又称“成本——效益分析。” 但由于医院的效益分析与企业不同,其主要效益不是物质产品和利润。成本效益分析法要求将任何效益都要换算为货币金额,并且对成本和效益金额都要计算贴现。而医院的经营效益难以完全用货币计量。迄今为止,在卫生经济中这个难点尚未完全解决。因此,尽管在部颁《医院分级管理标准》文件中已将进行“成本——效益分析”规定为管理标准的内容之一,然而严密的计算方法,并没有被采用。     

2004-2005年三门峡市结核病防治的卫生经济学评价

目的 分析评价三门峡市实施结核病控制项目的 社会效益与经济效益,为财政、卫生部门的卫生资源投入与使用提供科学依据. 方法 对2004-2005年全市结核病控制项目季报、年报及有关调查资料,做成本-效果分析、成本-效用分析、成本-效益分析. 结果 两年来利用项目经费160万元,治愈初、复治涂阳肺结核病人1 392例,预计减少的GDP损失和预计减少的收入损失分别为18 211.34万元、11 184.41万元,减少造成新的传染性病人2 088例. 结论 两年来三门峡市利用中央和地方专项经费防治结核病成效显著,是一项投入少、经济效益和社会效益巨大的疾病控制项目,完全符合疾病控制与卫生经济学成本的原则.     

湖北省世行贷款/英国赠款结核病控制项目经济学评价

目的从卫生经济学的角度评价湖北省世行贷款/英国赠款结核病控制项目,为结核病控制的可持续发展提供科学依据。方法收集2002～2007年湖北省项目资料,并通过问卷法进行补充,对项目进行成本—效果、成本—效用和成本—效益分析,分析项目直接、间接和潜在经济效益。结果2002～2007年发现活动性结核病人184694人,治愈173195人,项目共投入12540.2万元,发现并治愈1例活动性肺结核病人项目投入的平均费用为724元;共挽回1825302个伤残调整寿命年（DALY）,避免1614525人免受结核菌的感染,减少新发病人193743例;挽回国内生产总值（GDP）和病人个人可支配收入为2027545万元和1788796万元;估计减少直接、间接和潜在经济损失分别为62342万元、74224万元、161465万元,总经济成本/效益比为1∶23.8。结论湖北省世行贷款/英国赠款结核病控制项目符合低投入、高产出的经济学原则,可操作性强,经济效益显著,是一项非常值得借鉴和推广的疾病控制项目。     

What Is a Valid Mapping Algorithm in Cost-Utility Analyses? A Response From a Missing Data Perspective

ObjectivesAlthough numerous mapping algorithms from a non–preference-based measure to a target health utility measure have been developed and applied in cost-utility analyses (CUAs), conditions for a mapping algorithm to work well in a CUA are still unclear. In this research, we formulate the mapping problem as a missing data problem and clarify these conditions.MethodsWe defined a valid mapping algorithm based on the purpose of mapping (ie, not for prediction but for CUA), and derived a sufficient set of conditions for a valid mapping algorithm. We also conducted a simulation study to investigate properties of a mapping algorithm under situations where the conditions are satisfied and violated.ResultsThe derived sufficient conditions indicate that the complete overlap of the source measure with the target health utility measure is important and that a covariate that is omitted from a mapping algorithm but has an effect on the target health utility measure not captured by the source measure may invalidate a mapping algorithm. The conditions cannot be verified from data in a CUA but can be supported using external data. A simulation study showed that when at least 1 of the 3 conditions was violated, a mapping algorithm provided biased health utility estimates in a CUA, and that prediction accuracy did not necessarily reflect performance of a mapping algorithm in a CUA.ConclusionThe derived conditions provide a fundamental basis for better practices in developing and selecting a mapping algorithm.     

A tool to improve quality of reporting published economic analyses

OBJECTIVES: To test the feasibility of obtaining a baseline level of quality of reporting for cost-utility analysis (CUA) studies using the British Medical Journal economic submissions checklist, test interrater reliability of this tool, and discuss its longer term implications. METHODS: CUA studies in peer-reviewed English language journals in 1996, assessed using the British Medical Journal checklist, a quality index, and interrater reliability correlations. RESULTS: Forty-three CUA studies were assessed, with 23 checklist items acceptable and 10 items inadequate. Lowest quality scores were reported in specialist medical journals. Proportional agreement between assessors was over 80%. CONCLUSIONS: The British Medical Journal checklist is a feasible tool to collect baseline information on the quality of reporting in journals other than the British Medical Journal. Editors of specialist medical journals are in greatest need of economic guidance. If handled carefully, they might consider adopting the British Medical Journal checklist.     

Health outcome measures used in cost-effectiveness studies: a review of original articles published between 1986 and 1996

Theoretically, the preferred type of health economic evaluation is the cost-benefit approach in which costs as well as benefits are measured in monetary units. This type of analysis is rarely found in practice, however, where cost-effectiveness analysis (CEA), cost-utility analysis (CUA) and other forms of economic evaluations are instead favored. The use of quality adjusted life-years (QALYs) or life-years gained, if applicable, is generally recommended in CUA/CEA because these measures will make possible broad comparisons with other studies as well as with norms regarding society's willingness-to-pay for health benefits. The purpose of this paper is to study the choice of health outcome measures and the extent to which results from CUA and CEA are discussed from such a willingness-to-pay perspective. Based on the analysis of a sample of 455 studies included in the Health Economic Evaluations Database (HEED), it is concluded that major differences exist in the choice of health outcome measures across disease categories. There is no evidence that QALYs or life-years gained have become more common over the years and CEAs using intermediary outcome measures are as common as those using life-years gained. Furthermore, studies using QALYs or life-years gained often lack a relevant discussion of society's willingness-to-pay per QALY or life-years gained.     

The U.K. NHS economic evaluation database. Economic issues in evaluations of health technology

OBJECTIVE: The U.K. NHS Economic Evaluation Database (EED) project is commissioned to identify papers on economic evaluations of health technologies and to disseminate their findings to NHS decision makers by means of structured abstracts that are available through a public database and the Cochrane Library. This paper discusses current issues relating to the economic aspects of producing NHS EED abstracts. METHODS: A review of NHS EED was undertaken between 1994 and 1999 to determine the methodologies adopted and issues that influence the usefulness of economic evaluations. Methods adopted to improve the quality of NHS EED abstracts are also reported. RESULTS: Eighty-five percent of NHS EED abstracts are cost-effectiveness analyses (CEAs), 9.3% are cost-utility analyses (CUAs), and only 1.4% are cost-benefit analyses (CBAs). Of the total abstracts, 65.9% are based on single studies, 19.5% on reviews, 3.9% on estimates of effectiveness, and 10.7% on combinations of these sources. Models are utilized in 16.7% of CEAs, 60.2% of CUAs, and 20% of CBAs. Analyses of CBA studies reveal a degree of misuse of well-established definitions. NHS EED internal control mechanisms are reported that provide a means of ensuring that abstracts are based on sound academic principles. CONCLUSIONS: Most economic evaluations are conducted by means of CEA, followed by CUA, while CBA accounts for an extreme minority of cases. Single studies form the principal source of effectiveness data, although models are widely used, principally in CUA. The structure of NHS EED abstracts provides decision makers with the principal results and an interpretation of the relative strengths and weaknesses of economic evaluations.     

乌兰察布市人间布鲁杆菌病防治项目卫生经济学评价

目的通过对乌兰察布市布病防治项目的卫生经济学评价,为卫生资源的合理使用提供科学依据。方法采用成本—效果(CEA)、成本—效用(CUA)、成本—效益(CBA)三种评价方法对乌兰察布市2008-2013年人间布鲁杆菌病经费投入与产出进行卫生经济学评价。结果门诊平均一例布病患者费用472.52元;住院平均一例布病患者费用2 700.71元。2008-2013年乌兰察布市布病防治项目实施后共挽回DALY127480年,共获得1 803个完整生命。挽回GDP损失586 164.5万元,布病患者及时恢复健康,每年将为国家创造财富1 594.6万元。治愈布病避免了因布病造成的个人损失累计15 954.6万元。结论布病防治项目的实施是一项低投入高效益、高效用、高效果的策略。     

Estimating CHU-9D Utility Scores from the WAItE: A Mapping Algorithm for Economic Evaluation

Background

The Weight-Specific Adolescent Instrument for Economic Evaluation (WAItE) is a new condition-specific patient reported outcome measure that incorporates the views of adolescents in assessing the impact of above healthy weight status on key aspects of their lives. Presently it is not possible to use the WAItE to calculate quality adjusted life years (QALYs) for cost-utility analysis (CUA), given that utility scores are not available for health states described by the WAItE.

Qaly league tables: Handle with care

This paper examines some of the difficulties in using QALY league tables in priority setting. Such tables sometimes are seen as being ‘the’ way to prioritise in health care and in particular, at present, with respect to priority setting among purchasers in the UK NHS. However the paper highlights the fact that the base on which such tables is built is small—relatively few studies in the English language using CUA have been conducted anywhere. Further, four issues which require handling with care are set out: (i) the relevant measure of cost in QALY league tables has to be restricted to health service resource use; (ii) the relevant measure of benefit in QALY league tables is clearly restricted to QALYs, thereby the utility of health gains and indeed the maximisation of the utility of health gains; (iii) in incorporating the results of CUA studies into QALY league tables there is a need for greater clarification on what the margin constitutes; and (iv) those who might use CUA results in QALY league tables need to ascertain whether the original context of the study will allow the results to be transferred to the local context of the decision maker. The paper suggests that there is a need to be quite clear what goal QALY league tables serve. The authors argue that the only legitimate (and clearly important) goal of QALY league tables is the maximisation of the utility of health gains within a health service budget. The thinking underlying QALY league tables, adjusted to take account of the caveats in this paper, is the key to rational priority setting at a local level. It is this thinking that is to be emphasised rather than the use of ‘imported’ league tables or the use of results from CUA studies conducted elsewhere in the country or indeed in other countries. If results from elsewhere are to be used, the study context has to be examined carefully to establish the extent of its relevance to the local circumstances facing the purchasing authority.