Recommendations of the panel on cost-effectiveness in health and medicine
Recommendations of the panel on cost-effectiveness in health and medicine
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DOI：
10.1001/jama.276.15.1253
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发表时间：
1996-10-16
影响因子：
120.7
通讯作者：
Russell, LB
中科院分区：
文献类型：
--
作者：
Weinstein, MC;Siegel, JE;Russell, LB
客观。-为了制定基于共识的建议，进行成本效益分析（CEA），本文是3部分系列中的第二部分，介绍了构成参考案例分析的建议的基础，为指导CEA制定的一套实践，为社会资源分配决策提供信息，以及这些建议的内容。健康和医学成本效益小组是一个在CEA，临床医学，伦理学和健康结果测量方面具有专业知识的非联邦小组，由美国公共卫生服务（PHS）召集。专家组回顾了CEA的理论基础、当前实践以及分析中使用的替代方法，并在可能的情况下根据理论制定了建议，但考虑到伦理和务实因素以及用户的需求。该小组通过2年半的讨论提出了建议，并向联邦政府方法学家、卫生机构官员和学术方法学家征求了小组工作组编写的初稿的意见。该小组的方法建议涉及：（1）属于成本效益比率分子和分母的组成部分;（2）以成本效益比率分子衡量资源使用情况;（3）以成本效益比率分母评估健康后果;（4）估计干预措施的有效性;（5）纳入时间偏好和折扣;（6）处理不确定性，建议遵循“理性原则”，平衡实践带来的负担和研究的重要性。如果研究者遵循CEA的一套标准方法，研究的质量和可比性以及最终的效用都可以得到很大的提高。
Objective.-To develop consensus-based recommendations for the conduct of cost-effectiveness analysis (CEA), This article, the second in a 3-part series, describes the basis for recommendations constituting the reference case analysis, the set of practices developed to guide CEAs that inform societal resource allocation decisions, and the content of these recommendations.Participants.-The Panel on Cost-Effectiveness in Health and Medicine, a nonfederal panel with expertise in CEA, clinical medicine, ethics, and health outcomes measurement, was convened by the US Public Health Service (PHS).Evidence.-The panel reviewed the theoretical foundations of CEA, current practices, and alternative methods used in analyses, Recommendations were developed on the basis of theory where possible, but tempered by ethical and pragmatic considerations, as well as the needs of users.Consensus Process.-The panel developed recommendations through 2 1/2 years of discussions, Comments on preliminary drafts prepared by panel working groups were solicited from federal government methodologists, health agency officials, and academic methodologists.Conclusions.-The panel's methodological recommendations address (1) components belonging in the numerator and denominator of a cost-effectiveness (C/E) ratio; (2) measuring resource use in the numerator of a C/E ratio; (3) valuing health consequences in the denominator of a C/E ratio; (4) estimating effectiveness of interventions; (5) incorporating time preference and discounting; and (6) handling uncertainty, Recommendations are subject to the ''rule of reason,'' balancing the burden engendered by a practice with its importance to a study, If researchers follow a standard set of methods in CEA, the quality and comparability of studies, and their ultimate utility, can be much improved.