Incremental cost-effectiveness ratios (ICERs): The silence of the lambda
Incremental cost-effectiveness ratios (ICERs): The silence of the lambda
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DOI：
10.1016/j.socscimed.2005.10.023
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发表时间：
2006-05-01
影响因子：
5.4
通讯作者：
Birch, S
中科院分区：
文献类型：
--
作者：
Gafni, A;Birch, S
尽管门槛增量成本效益比(ICER)或lambda(Lambda)在成本效益分析(CEA)的方法和应用中发挥了核心作用，但对lambda的价值的确定却很少关注。在这篇文章中，我们考虑‘是什么解释了兰姆达的沉默’？对门槛ICER的概念进行了批判性评价。我们发现，在ICER阈值的价值的合理性、它们在决策中的使用以及它们与边际资源的机会成本的关系方面，存在着“沉默”。此外，“沉默之声”延伸到了“自动切断”和更复杂的使用lambda来确定有关医疗保健计划的建议的方法。我们认为，阈值没有提供有用的信息来确定使用现有资源支持新的医疗保健计划的效率。相反，门槛方法导致了导致医疗保健计划支出增加的决定，并在没有任何证据表明总健康收益增加的情况下，对医疗保健计划公共资金的可持续性表示担忧。为了提高资源分配的效率，决策者需要有关项目机会成本的信息。(C)2005爱思唯尔有限公司。保留所有权利。
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. (c) 2005 Elsevier Ltd. All rights reserved.