The cost-benefit of a randomized trial to a health care organization
The cost-benefit of a randomized trial to a health care organization
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DOI：
10.1016/s0197-2456(97)00098-6
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发表时间：
1998-04-01
期刊：
影响因子：
--
通讯作者：
Eghtesady, P
中科院分区：
文献类型：
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作者：
Hornberger, J;Eghtesady, P
临床医生和患者在最佳治疗不确定的情况下做出许多决定。尽管临床试验在减少这种不确定性方面具有广泛的优势，但由于经典的假设检验方法所指示的样本量太大，以至于没有一个机构能够赞助该试验，因此可能无法进行试验。通过明确考虑试验的成本和收益，贝叶斯统计方法允许估计进行随机试验的医疗保健组织的价值，而不是在缺乏更多信息的情况下继续治疗患者。本文介绍了一种方法来计算成本效益的医疗机构进行临床试验，以及预期的样本量，以充分解决的不确定性，哪种治疗是更好的。该方法是说明的情况下，拟议的临床试验的药物，以防止多器官系统衰竭和死亡的病人承认的斯坦福大学外科重症监护病房。这种方法应允许医疗保健组织评估拟议试验的预期成本效益和预期样本量，以解决利益问题，从而帮助决定是否进行试验。(C)Elsevier Science Inc. 1998.
Clinicians and patients make many decisions in situations where optimal treatment is uncertain. Despite well-published advantages of clinical trials for reducing such uncertainties, a trial may not be conducted because the sample size indicated by classical, hypothesis-testing methods is so large that no one institution could afford to sponsor the trial. By explicitly taking into consideration the costs and benefits of a trial, Bayesian statistical methods permit estimation of the value to a health care organization conducting a randomized trial instead of continuing to treat patients in the absence of more information. This paper describes a method for calculating the cost-benefit to a health care organization conducting a clinical trial, and the expected sample size to adequately resolve the uncertainties about which treatment is better. The method is illustrated in the case of a proposed clinical trial of a drug to prevent multiorgan system failure and death in patients admitted to the Stanford University surgical intensive care unit. This method should permit health care organizations to evaluate a proposed trial's expected cost-benefit and the expected sample size that will resolve the question of interest, and thereby assist in the process of deciding whether to conduct the trial. (C) Elsevier Science Inc. 1998.