Value of information on preference heterogeneity and individualized care
Value of information on preference heterogeneity and individualized care
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DOI：
10.1177/0272989x06297393
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发表时间：
2007-03-01
影响因子：
3.6
通讯作者：
Meltzer, David
中科院分区：
文献类型：
--
作者：
Basu, Anirban;Meltzer, David
背景成本效益分析传统上侧重于根据其在人群中的平均效益和成本来确定治疗何时具有成本效益。然而，鉴于患者的偏好或其他个人属性，确定治疗何时对个体患者具有成本效益可能具有相当大的价值。目标.提出一个理论框架，以评估确定具有成本效益的治疗方案的潜在价值，为个人患者的喜好，并比较个性化的治疗决策的价值与传统的人口水平的成本效益分析的基础上的治疗决策的价值。方法.作者计算了个体化护理的期望值（EVIC），它代表了向医生提供个体患者偏好信息的潜在价值，例如生活质量（QOL）权重，以便做出个体化治疗决策。他们还显示了EVIC如何随着保险结构的变化而变化，这些保险结构没有内化治疗的相对成本。他们用一个例子来说明这一理论，在这个例子中，医生为65岁的前列腺癌患者做出治疗选择。结果在美国，为65岁的前列腺癌患者确定个体水平的成本效益治疗的价值每年约为7000万美元。这是为这一人群确定具有成本效益的治疗方法的平均年价值70万美元的100多倍。然而，未能内化成本几乎消除了个性化护理的价值：结论。个性化护理的价值可能远远大于在群体水平上改进决策的价值。然而，这可能与保险有很大的不同。EVIC可以提供一个指南，说明个性化护理的高价值何时可能使人口层面的决策，特别是在为覆盖决策提供不良指导的风险。未来对个体化护理价值的研究还应考虑个体化护理的基线水平。
Background. Cost-effectiveness analysis traditionally focuses on identifying when treatments are cost-effective based on their average benefits and costs in the population. However, there may be considerable value in identifying when treatments are cost-effective for individual patients given their preferences or other personal attributes. Objectives. To present a theoretical framework to assess the potential value of identifying cost-effective treatments for individual patients given their preferences and to compare the value of individualized treatment decisions with the value of treatment decisions based on traditional population-level cost-effectiveness analysis. Methods. The authors calculate the expected value of individualized care (EVIC), which represents the potential value of providing physicians information on the preferences of individual patients, such as quality-of-life (QOL) weights, so as to make individualized treatment decisions. They also show how EVIC varies with insurance structures that do not internalize relative costs of treatments. They illustrate this theory using an example in which physicians make treatment choices for 65-year-old prostate cancer patients. Results. The value of identifying cost-effective treatments at the individual level for 65-year-old prostate cancer patients in the United States is about $70 million annually. This is more than 100 times the $0.7 million annual value of identifying the cost-effective treatment on average for this population. However, failure to internalize costs almost eliminates the value of individualized care: Conclusions. The value of individualizing care can be far greater than the value of improved decision making at the group level. However, this can vary immensely with insurance. EVIC can provide a guide as to when the high value of individualized care may make population-level decision making especially at risk of providing poor guidance for coverage decisions. Future studies of the value of individualized care should also consider baseline levels of individualization of care.