Approaches to economic evaluation in telemedicine
Approaches to economic evaluation in telemedicine
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DOI：
10.1258/jtt.2012.111112
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发表时间：
2012-01-01
影响因子：
4.7
通讯作者：
Bergmo, Trine S.
中科院分区：
文献类型：
--
作者：
Bergmo, Trine S.
外部有效性或可推广性是远程医疗经济评价中的一个主要挑战。有两种可能的方法来提高普遍性：第一种是使用务实的试验设计，使其更好地反映正常的患者病例量和日常实践。第二种方法是利用文献和决策模型中的现有数据来估计不同替代方案的预期成本和结果。第一个将增加对其他患者的普遍性，而不是试验中的患者，第二个将增加从一个地方到另一个地方的普遍性。评价的目标和作用将决定最适当的评价方法。如果研究的目的是为特定环境中的特定患者群体提供成本和结局的测量，则应使用实用性试验。这一方法与远程医学评价高度相关，其目标是支持地方投资战略和偿还制度。决策建模为决策问题提供了一个整体结构，并对不同决策的含义进行了正式分析。建模可以模拟试验或模仿当前系统或决策者想要使用的系统。当需要在更广泛的范围内决定是否投资于远程医疗时，建模是一种有用的方法。
External validity or generalizability is a major challenge in the economic evaluation of telemedicine. There are two possible ways of increasing generalizability: the first is to use a pragmatic trial design so it better reflects normal patient caseload and everyday practice. The second is to use existing data from the literature and decision modelling to estimate the expected costs and outcomes of different alternatives. The first will increase generalizability to other patients than those in the trial and the second will increase generalizability from place to place. The objective and role of the evaluation will decide the most appropriate evaluation approach. Pragmatic trials should be used in studies where the objective is to provide measurements of costs and outcomes for a specific group of patients in a particular setting. This approach is highly relevant in telennedicine evaluations where the objective is to support local investments strategies and reimbursement systems. Decision modelling provides an overall structure for a decision problem and a formal analysis of the implications of different decisions. Modelling can simulate a trial or mimic a current system or a system that decision makers would like to use. Modelling is a useful approach when decisions need to be made about whether to invest in telemedicine within a broader context.