Information created to evade reality (ICER) - Things we should not look to for answers
Information created to evade reality (ICER) - Things we should not look to for answers
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DOI：
10.2165/00019053-200624110-00008
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发表时间：
2006-01-01
影响因子：
4.4
通讯作者：
Gafni, Amiram
中科院分区：
文献类型：
--
作者：
Birch, Stephen;Gafni, Amiram
成本效益分析在卫生经济学方法文献中得到提倡，并被越来越多的司法管辖区采用，作为负责从现有资源中获得最大卫生效益的决策者的证据基础。本文批判性地评价了成本效益分析产生的信息，特别是增量成本效益比（ICER）。结果表明，该比率被用作非可比选项的比较信息，从而回避了决策者问题的现实。ICER方法的理论基础是对与决策者情境无关的理论假设的简化。尽管替代的、完善的方法可以用于解决决策者的问题，但面对越来越多的证据表明成本效益方法在理论和经验上的失败，该方法的一些支持者现在建议改变研究问题以适应该方法，而不是采用更合适的方法来解决当前和持续的问题。只要决策者关心如何最大限度地利用现有的医疗资源，成本效益分析和ICER就不应该成为我们寻找答案的地方。
Cost-effectiveness analysis has been advocated in the health economics methods literature and adopted in a growing number of jurisdictions as an evidence base for decision makers charged with maximising health gains from available resources.This paper critically appraises the information generated by cost-effectiveness analysis, in particular the incremental cost-effectiveness ratio (ICER). It is shown that this ratio is used as comparative information on what are non-comparable options and hence evades the reality of the decision-maker's problem. The theoretical basis for the ICER approach is the simplification of theoretical assumptions that have no relevance to the decision maker's context. Although alternative, well established methods can be used for addressing the decision maker's problem, faced with the increasing evidence of the theoretical and empirical failures of the cost-effectiveness approach, some proponents of the approach now propose changing the research question to suit the approach as opposed to adopting a more appropriate method for the prevailing and continuing problem.As long as decision makers are concerned with making the best use of available healthcare resources, cost-effectiveness analysis and the ICER should not be where we look for answers.