Economic evaluation and decision making in the UK
Economic evaluation and decision making in the UK
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DOI：
10.2165/00019053-200624110-00009
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发表时间：
2006-01-01
影响因子：
4.4
通讯作者：
Buxton, Martin J.
中科院分区：
文献类型：
--
作者：
Buxton, Martin J.
本文回顾了英国卫生技术经济评估的发展及其对决策的影响。在主要作为学术活动进行的研究产生了很长一段时间的有限影响之后，1999年国家卫生和临床卓越研究所(NICE)的成立提供了一个透明的决策环境，其中经济评估发挥了核心作用。这篇文章回顾了NICE工作方式的一些关键特征，例如，NICE定义了它所需的分析形式，反映了它的目标是从预先确定的和有限的英国NHS预算中最大化健康收益(QALY)。第一个问题涉及NICE使用的成本效益阈值及其依据。第二个问题是NICE指南的实施参差不齐，以及造成这种情况的可能原因。但即使在英国，NICE在广泛而明确地使用经济评估方面也是个例外，本文继续建议，如果要在中央和地方层面更广泛、更一致地使用经济评估，那么健康经济学家和其他人需要解决三个问题。第一，明确确定成本效益门槛的正确概念基础是什么，然后确保NICE拥有适当设置它的经验证据。第二是要认识到，即使使用NICE采用的有限的成本观点，经济评估也意味着时间和跨服务的预算灵活性，而NHS在当地实际上并不享有这种灵活性。第三个问题是，随着学术压力要求不断提高最先进的经济评估分析的复杂性，NHS对仅有几项新技术的成本效益有了越来越准确的理解，而对大多数技术的分析却很少或根本没有。这限制了前者的价值，因为它进一步缩小了适当减少对成本效益不高的技术的投资以满足投资于成本效益高的新技术的额外成本的范围。尽管NICE是高质量经济评估在决策中发挥主要作用的一个例子，但这一过程远不是完美的，当然也不能代表NHS作为一个整体使用经济评估的情况。卫生经济学家需要与公众和卫生服务机构接触，以更好地理解他们的观点，而不是专注于与理论和分析方法细节有关的学术关切。
This article reviews the development of economic evaluation of health technologies in the UK and its impact on decision making. After a long period of limited impact from studies mainly carried out as academic exercises, the advent of the National Institute for Health and Clinical Excellence (NICE) in 1999 provided a transparent decision-making context where economic evaluation plays a central role. This article reviews some of the key characteristics about the way NICE works, for example, the way NICE has defined the form of analysis that it requires, reflecting its objective of maximising health gain (QALYs) from the predetermined and limited UK NHS budget.Two broad areas of widespread concern are noted. The first relates to the cost-effectiveness thresholds that NICE uses and the basis for them. The second is the patchy implementation of NICE guidance and the possible reasons for this. But even within the UK, NICE is the exception in making extensive and explicit use of economic evaluation and this article goes on to suggest that if there is to be a more widespread and consistent use of economic evaluation at both central and local levels, then health economists and others need to address three issues.The first is to be clear about what is the correct conceptual basis for determining the cost-effectiveness threshold and then to ensure that NICE has the empirical evidence to set it appropriately. The second is to recognise that even using the limited view of costs adopted by NICE, economic evaluations imply temporal and cross-service budgetary flexibility that the NHS locally does not in practice enjoy. The third issue is that with academic pressures for ever-increasing sophistication of 'state of the art' economic evaluation analysis, the NHS has more and more precise understanding of the cost effectiveness of just a few new technologies and little or no analysis of most. This limits the value of the former by reducing further the scope for appropriately disinvesting from cost-ineffective technologies to meet the additional costs of investing in cost-effective new ones.Whilst NICE stands out as an example of a context where high-quality economic evaluation plays a major role in decision making, the process is far from perfect and certainly is not representative of the use made of economic evaluation by the NHS as a whole. Health economists need to engage with the public and the health service to better understand their perspectives, rather than focusing on academic concerns relating to details of theory and analytical method.