The Role of Economic Perspectives and Evidence in Systematic Review
The Role of Economic Perspectives and Evidence in Systematic Review
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经济观点和证据在系统审查中的作用
DOI：
10.1002/9781444320398.ch3
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发表时间：
2010
影响因子：
3.2
通讯作者：
I. Shemilt
中科院分区：
文献类型：
--
作者：
Rob W Anderson;I. Shemilt
基于证据的政策制定的核心是一个尴尬的事实。这就是，对于任何给定的政策选择，在特定的时间和特定的国家或组织，将不会有一个完整的实证研究，产生理想的和完全适用的证据，为知情的选择。相反，政策制定者最多只能从一些部分相关的研究中汲取经验，为特定的政策选择提供信息（另见第5章）。这是一个不可避免的事实，需要系统的审查方法，或某种透明和可信的方法来识别，整合和权衡来自不同来源的证据，在循证决策的核心。使问题复杂化的另一个不言而喻的事实是，决策者有多重目标。例如，关于改变卫生服务组织的合理决定不仅要考虑替代方案对健康结果的影响，还要考虑可及性和覆盖范围等问题;可能的危害和安全影响;服务响应和患者满意度;当然，还有成本和预算影响。在公共政策的其他领域，如运输或环境，不同目标或潜在影响类型的数量可能更多。然而，在许多政策过程中，决策者的关键信息需求往往被简化为寻求两个问题的答案：“什么最有效？”和“它值这个钱吗？”也就是说，成本和成本效益（或成本效益）的考虑与有利和不利影响的考虑一样至关重要。因此，对经济证据的某种考虑往往是明确要求或隐含期望的。但怎么做呢？本章考虑这两个真理的共同影响：政策制定者应该考虑经济证据，这些证据通常存在于一些研究中，其中每一个都只是部分相关的具体政策选择。本章首先简要介绍了影响循证决策的一些主要经济观点。接下来的一节描述了对经济证据进行系统审查的做法的兴起（特别是在卫生保健方面），并包括目前可用于协助此类审查的指导方针和其他资源的概要（另见第七章和第八章等）。接下来，介绍了审查经济证据所涉及的一些挑战，并介绍了一个案例研究，介绍了对成本数据进行荟萃分析的罕见尝试之一。接下来的一节考虑了在不同的应用领域，如社会福利、教育和刑事司法，以及在发展中国家，对经济研究进行系统审查的程度（a）可行性和（B）实际进行的程度。
At the heart of evidence-based policy making lies an awkward truth. It is that, for any given policy choice, at a particular time and in a specific country or organisation, there will be no single completed empirical study which generates the ideal and totally applicable evidence for informing that choice. Instead, at best, policy makers must somehow draw upon a number of partially relevant research studies which can inform a given policy choice (see also Chapter 5). It is this inevitable fact which places the need for systematic review methods–or some kind of transparent and credible approach for identifying, integrating and weighing up evidence from different sources–at the heart of evidence-based policy making. Another truism which complicates matters is that policy makers have multiple objectives. For example, a defensible decision about changing the organisation of a health service will have to consider not only the impact of alternatives on health outcomes but also issues such as accessibility and coverage; possible harms and safety impacts; service responsiveness and patient satisfaction; and of course, the cost and budget impact. In other areas of public policy, such as transport or the environment, the number of different objectives or types of potential impact may be even greater. However, in many policy processes, the critical information needs of policy makers are often reduced to seeking an answer to two questions:‘What works (best)?’and ‘Is it worth the money?’. That is, considerations of cost and cost-effectiveness (or costbenefit) are paramount alongside consideration of beneficial and adverse effects. Therefore some kind of consideration of economic evidence is often explicitly required or implicitly expected. But how? This chapter considers the joint implications of these two truisms: that policy makers should consider economic evidence, and that such evidence will typically reside in a number of studies, each of which is only partially relevant to the specific policy choice faced. The chapter opens by briefly identifying some of the main economic perspectives that impinge on evidence-based decision making. This is followed by a section describing the rise in the practice of conducting systematic reviews of economic evidence (most notably in health care), and includes an outline of current guidance and other resources currently available to assist in such reviews (see also, inter alia, Chapters 7 and 8).Next, some of the challenges involved in conducting reviews of economic evidence are described, and a case study profiling one of the rare attempts to conduct a meta-analysis of cost data is presented. This is followed by a section that considers the extent to which systematic reviews of economic studies are (a) feasible and (b) actually conducted, in different applied fields, such as social welfare, education and criminal justice, and in developing countries.