The Anatomy of Medical Research US and International Comparisons
The Anatomy of Medical Research US and International Comparisons
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DOI：
10.1001/jama.2014.15939
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发表时间：
2015-01-13
影响因子：
120.7
通讯作者：
Dorsey, E. Ray
中科院分区：
文献类型：
--
作者：
Moses, Hamilton, III;Matheson, David H. M.;Dorsey, E. Ray
医学研究是临床进步的先决条件，而卫生服务研究支持改善提供、获取和成本。此前很少有分析将美国与其他发达国家进行比较。量化公共和私人投资和人员总量（经济投入），并评估由此产生的专利、出版物、药品和器械批准以及创造的价值（经济产出）。1994年至2012年的公开数据汇编显示了按来源和行业类型划分的美国和国际研究经费、生产力和疾病负担的趋势。使用引用率和影响因子对专利和出版物（1981-2011）进行评估。研究发现(1)科研投入减少：1994-2004年，美国科研经费总额每年增长6%，但2004-2012年增长率降至每年0.8%，达到1170亿美元（占医疗保健总支出的4.5%）。私人来源从1994年的46%增加到2012年的58%。工业界减少了早期研究，转而支持医疗设备、生物工程药物和后期临床试验，特别是针对癌症和罕见疾病的临床试验。国家卫生研究院的拨款与疾病负担不完全相关，癌症和艾滋病毒/艾滋病得到的支助不成比例。(2)服务创新资金不足：卫生服务研究获得50亿美元（占卫生保健总支出的0.3%），仅占科学资金的1/20。在22个行业的创新投资中，私营保险公司排名最后（占收入的0.04%），医疗系统排名第19（占收入的0.1%）。如果服务公司的研发经费达到中位数，每年将增加80亿至150亿美元。(3)全球化：美国政府研究经费占全球总量的比例从57%（2004年）下降到50%（2012年），美国公司的研究经费占全球总量的比例从50%下降到41%，美国（公共和私人）在全球研究经费中所占的份额从57%下降到44%。亚洲，特别是中国，在教育和人才方面的投资增加了两倍，从2004年的26亿美元增加到2012年的97亿美元。美国在生命科学专利中的份额从57%（1981年）下降到51%（2011年），那些被认为最有价值的专利也从73%（1981年）下降到59%（2011年）。如果要充分实现过去的科学发现的临床价值和改善护理的机会，就需要新的投资。资金来源可能包括外国资本回流、新的创新债券、行政储蓄、专利池和公私风险分担合作。鉴于国际趋势，除非采取这些措施，否则美国将在未来十年放弃其历史上的国际领先地位。
IMPORTANCE Medical research is a prerequisite of clinical advances, while health service research supports improved delivery, access, and cost. Few previous analyses have compared the United States with other developed countries.OBJECTIVES To quantify total public and private investment and personnel (economic inputs) and to evaluate resulting patents, publications, drug and device approvals, and value created (economic outputs).EVIDENCE REVIEW Publicly available data from 1994 to 2012 were compiled showing trends in US and international research funding, productivity, and disease burden by source and industry type. Patents and publications (1981-2011) were evaluated using citation rates and impact factors.FINDINGS (1) Reduced science investment: Total US funding increased 6% per year (1994-2004), but rate of growth declined to 0.8% per year (2004-2012), reaching $117 billion (4.5%) of total health care expenditures. Private sources increased from 46%(1994) to 58% (2012). Industry reduced early-stage research, favoring medical devices, bioengineered drugs, and late-stage clinical trials, particularly for cancer and rare diseases. National Insitutes of Health allocations correlate imperfectly with disease burden, with cancer and HIV/AIDS receiving disproportionate support. (2) Underfunding of service innovation: Health services research receives $5.0 billion (0.3% of total health care expenditures) or only 1/20th of science funding. Private insurers ranked last (0.04% of revenue) and health systems 19th (0.1% of revenue) among 22 industries in their investment in innovation. An increment of $8 billion to $15 billion yearly would occur if service firms were to reach median research and development funding. (3) Globalization: US government research funding declined from 57%(2004) to 50% (2012) of the global total, as did that of US companies (50% to 41%), with the total US (public plus private) share of global research funding declining from 57% to 44%. Asia, particularly China, tripled investment from $2.6 billion (2004) to $9.7 billion (2012) preferentially for education and personnel. The US share of life science patents declined from 57%(1981) to 51%(2011), as did those considered most valuable, from 73% (1981) to 59%(2011).CONCLUSIONS AND RELEVANCE New investment is required if the clinical value of past scientific discoveries and opportunities to improve care are to be fully realized. Sources could include repatriation of foreign capital, new innovation bonds, administrative savings, patent pools, and public-private risk sharing collaborations. Given international trends, the United States will relinquish its historical international lead in the next decade unless such measures are undertaken.