Thresholds for the cost-effectiveness of interventions: alternative approaches.
Thresholds for the cost-effectiveness of interventions: alternative approaches.
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DOI：
10.2471/blt.14.138206
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发表时间：
2015-02-01
影响因子：
11.1
通讯作者：
Rosen S
中科院分区：
文献类型：
--
作者：
Marseille E;Larson B;Kazi DS;Kahn JG;Rosen S
许多国家在评价卫生干预措施时使用世界卫生组织“选择具有成本效益的干预措施”项目建议的成本效益阈值。该项目将成本效益的阈值定为每残疾调整生命年避免的干预费用不到该国年人均国内生产总值的三倍。高成本效益的干预措施被定义为达到每DALY的阈值，避免了人均年国内生产总值的一次。我们认为，依赖于这些阈值降低了成本效益分析的价值，并使这种分析过于生硬，是有用的公共卫生领域的大多数决策。使用这些阈值在理论上没有什么道理，绕过了对当地适用的干预措施的相对价值进行困难但必要的排序，并忽略了对真正负担得起的费用的任何考虑。世卫组织选择阈值设定的成本效益门槛如此之低，以至于几乎没有有效证据的干预措施可以被排除。阈值对于评估决策者必须面对的权衡没有什么价值。我们提出了替代方法，应用成本效益标准的选择，在卫生保健资源的分配。
Many countries use the cost–effectiveness thresholds recommended by the World Health Organization’s Choosing Interventions that are Cost–Effective project (WHO-CHOICE) when evaluating health interventions. This project sets the threshold for cost–effectiveness as the cost of the intervention per disability-adjusted life-year (DALY) averted less than three times the country’s annual gross domestic product (GDP) per capita. Highly cost–effective interventions are defined as meeting a threshold per DALY averted of once the annual GDP per capita. We argue that reliance on these thresholds reduces the value of cost–effectiveness analyses and makes such analyses too blunt to be useful for most decision-making in the field of public health. Use of these thresholds has little theoretical justification, skirts the difficult but necessary ranking of the relative values of locally-applicable interventions and omits any consideration of what is truly affordable. The WHO-CHOICE thresholds set such a low bar for cost–effectiveness that very few interventions with evidence of efficacy can be ruled out. The thresholds have little value in assessing the trade-offs that decision-makers must confront. We present alternative approaches for applying cost–effectiveness criteria to choices in the allocation of health-care resources.