Using Multicriteria Approaches to Assess the Value of Health Care
Using Multicriteria Approaches to Assess the Value of Health Care
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DOI：
10.1016/j.jval.2016.11.011
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发表时间：
2017-02-01
期刊：
影响因子：
4.5
通讯作者：
Madhavan, Guruprasad
中科院分区：
文献类型：
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作者：
Phelps, Charles E.;Madhavan, Guruprasad
成本效用分析的从业者知道，他们的模型忽略了几个重要的因素，这些因素往往会影响现实世界对医疗保健选择的决定。此外，成本效用分析通常只反映单一的观点（例如，个人，企业和社会），进一步限制了具有不同观点的人（患者，提供者，付款人，生产者和规划者5P）的价值。我们将讨论如何基于多标准分析，从多个角度来看问题的模型，可以填补这一空白。5P中的每一个都可以以不同的方式使用多标准分析来帮助他们做出决策。每一种视角都可能导致不同的价值度量和结果，而没有一种单一的度量方法（如成本效用分析）可以满足所有这些利益相关者的要求。所有利益相关者都有独特的方法来衡量价值，即使评估相同的健康干预措施。我们通过比较五种不同的假设治疗选择对五个假设癌症患者的价值来说明这种方法的好处，每个患者都有不同的偏好结构。九个属性描述了每个治疗选项。我们添加了一个简短的讨论，这些方法在基于组的决策。我们敦促评估健康干预措施的方法包括我们讨论的多标准方法，因为这些方法1）提高决策过程的透明度，2）允许在实际投资或部署之前对替代干预措施进行飞行模拟器类型评估，3）帮助集中精力以有效的方式改善数据，4）至少在某些情况下有助于促进不同观点的利益相关者之间的决策趋同，以及5）有助于避免已知会损害直觉判断的潜在认知错误。
Practitioners of cost-utility analysis know that their models omit several important factors that often affect real-world decisions about health care options. Furthermore, cost-utility analyses typically reflect only single perspectives (e.g., individual, business, and societal), further limiting the value for those with different perspectives (patients, providers, payers, producers, and planners the 5Ps). We discuss how models based on multicriteria analyses, which look at problems from many perspectives, can fill this void. Each of the 5Ps can use multicriteria analyses in different ways to aid their decisions. Each perspective may lead to different value measures and outcomes, whereas no single-metric approach (such as cost-utility analysis) can satisfy all these stakeholders. All stakeholders have unique ways to measure value, even if assessing the same health intervention. We illustrate the benefits of this approach by comparing the value of five different hypothetical treatment choices for five hypothetical patients with cancer, each with different preference structures. Nine attributes describe each treatment option. We add a brief discussion regarding the use of these approaches in group-based decisions. We urge that methods to value health interventions embrace the multicriteria approaches that we discuss, because these approaches 1) increase transparency about the decision process, 2) allow flight simulator type evaluation of alternative interventions before actual investment or deployment, 3) help focus efforts to improve data in an efficient manner, 4) at least in some cases help facilitate decision convergence among stakeholders with differing perspectives, and 5) help avoid potential cognitive errors known to impair intuitive judgments.