Basic Attitude of Japanese Physicians towards Healthcare Resource Allocation in a Setting of Budget Constraints.
Basic Attitude of Japanese Physicians towards Healthcare Resource Allocation in a Setting of Budget Constraints.
复制标题
预算约束下日本医生对医疗资源配置的基本态度。
DOI：
10.1007/s40258-016-0236-3
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发表时间：
2015
期刊：
影响因子：
4.5
通讯作者：
Shimozuma K
中科院分区：
文献类型：
--
作者：
Saito S;Shiroiwa T;Fukuda T;Shimozuma K
背景和目的尽管质量调整寿命年(QALY)可能不能完全反映医疗保健技术的价值，但如何调整每QALY的成本阈值仍不清楚。首先，本研究比较了两种调查方法，当每种选择都具有相同的效率时，这两种调查方法衡量人们对特定医疗技术的偏好。第二个目标是考虑如何将有关偏好的信息用于决策。方法我们进行了单属性(预算分配)和多属性(离散选择)实验来调查公共医疗偏好。每项实验都抽样调查了大约1000名受访者。编写了六个问题来回答研究报告中包括的属性：(A)年龄；(B)护理目标；(C)疾病严重程度；(D)既往医疗护理；(E)疾病原因；(F)疾病频率。对于离散选择实验，(A)年龄、(B)护理目标、(C)疾病严重程度和(D)既往医疗护理被正交组合。所有患者均假定医疗保健具有相同的成本和增量成本-效果比(ICER；每生命年成本或QALY)。我们还计算了反映人们在一个阈值范围内的偏好的偏好调整阈值(PAT)。结果两个实验的结果都显示出相似的偏好：尽管每个生命年或QALY的成本相同，但对年轻患者的干预更受欢迎，其次是治疗干预和严重疾病状态。单属性实验显示，许多人更喜欢在两种干预措施之间平等分配资源的选项。根据年龄、护理目标、疾病严重程度和既往医疗护理计算边际PATS。结论单属性和多属性实验显示出相似的偏好。PAT可以在决策者的阈值范围内以数字的方式反映人们的偏好。
Background and ObjectivesAlthough quality-adjusted life-years (QALYs) may not completely reflect the value of a healthcare technology, it remains unclear how to adjust the cost per QALY threshold. First, the present study compares two survey methods of measuring people’s preferences for a specific healthcare technology when each choice has the same efficiency. The second objective was to consider how this information regarding preferences could be used in decision making.MethodsWe conducted single-attribute (budget allocation) and multi-attribute (discrete-choice) experiments to survey public medical care preferences. Approximately 1000 respondents were sampled for each experiment. Six questions were prepared to address the attributes included in the study: (a) age; (b) objective of care; (c) disease severity; (d) prior medical care; (e) cause of disease; and (f) disease frequency. For the discrete-choice experiment (a) age, (b) objective of care, (c) disease severity, and (d) prior medical care were orthogonally combined. All assumed medical care had the same costs and incremental cost-effectiveness ratio (ICER; cost per life-year or QALY). We also calculated the preference-adjusted threshold (PAT) to reflect people’s preferences in a threshold range.ResultsThe results of both experiments revealed similar preferences: intervention for younger patients was strongly preferred, followed by interventions for treatment and severe disease states being preferred, despite the same cost per life-year or QALY. The single-attribute experiment revealed that many people prefer an option in which resources are equally allocated between two interventions. Marginal PATs were calculated for age, objective of care, disease severity, and prior medical care.ConclusionThe single- and multi-attribute experiments revealed similar preferences. PAT can reflect people’s preferences within the decision-maker’s threshold range in a numerical manner.