Evaluating Frameworks That Provide Value Measures for Health Care Interventions
Evaluating Frameworks That Provide Value Measures for Health Care Interventions
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DOI：
10.1016/j.jval.2016.11.013
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发表时间：
2017-02-01
期刊：
影响因子：
4.5
通讯作者：
Phelps, Charles E.
中科院分区：
文献类型：
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作者：
Mandelblatt, Jeanne S.;Ramsey, Scott D.;Phelps, Charles E.
最近科学发现的加速使医疗保健有了更多的选择。新技术、诊断测试和药物在效益、毒性和成本方面对患者和人群产生了广泛不同的影响，促使人们重新关注建立旨在衡量健康价值的框架。其中许多是由对特定疾病（例如癌症和心脏病）具有专门知识和兴趣的提供者和/或宣传组织提供的。为了帮助评估这些框架的效用和潜在偏差，我们创建了一个评估分类法，包括七个基本组成部分：1)定义目的；2)详细说明概念方法，包括视角、获取决策者（如患者）偏好的方法，以及整合多个价值维度的能力；3)讨论框架中包含的要素的包括和排除，以及框架是否需要临床干预或提供替代方案，如姑息治疗或观察等待；4)评估数据来源及其科学有效性；5)评估干预措施对特定人群治疗总成本的影响；6)分析如何纳入不确定性；7)阐明创建框架的人之间可能存在的利益冲突。我们将分类法应用于最近由专注于癌症和心脏病治疗以及疫苗使用的专业组织发布的四个具有代表性的价值框架。我们的结论是，当使用我们的分类法进行评估时，这些努力都有优点和缺点，并提出了提高政策和临床决策中价值评估框架效用的途径。
The recent acceleration of scientific discovery has led to greater choices in health care. New technologies, diagnostic tests, and pharmaceuticals have widely varying impact on patients and populations in terms of benefits, toxicities, and costs, stimulating a resurgence of interest in the creation of frameworks intended to measure value in health. Many of these are offered by providers and/ or advocacy organizations with expertise and interest in specific diseases (e.g., cancer and heart disease). To help assess the utility of and the potential biases embedded in these frameworks, we created an evaluation taxonomy with seven basic components: 1) define the purpose; 2) detail the conceptual approach, including perspectives, methods for obtaining preferences of decision makers (e.g., patients), and ability to incorporate multiple dimensions of value; 3) discuss inclusions and exclusions of elements included in the framework, and whether the framework assumes clinical intervention or offers alternatives such as palliative care or watchful waiting; 4) evaluate data sources and their scientific validity; 5) assess the intervention's effect on total costs of treating a defined population; 6) analyze how uncertainty is incorporated; and 7) illuminate possible conflicts of interest among those creating the framework. We apply the taxonomy to four representative value frameworks recently published by professional organizations focused on treatment of cancer and heart disease and on vaccine use. We conclude that each of these efforts has strengths and weaknesses when evaluated using our taxonomy, and suggest pathways to enhance the utility of value-assessing frameworks for policy and clinical decision making.