Adapting portfolio theory for the evaluation of multiple investments in health with a multiplicative extension for treatment synergies.
Adapting portfolio theory for the evaluation of multiple investments in health with a multiplicative extension for treatment synergies.
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DOI：
10.1007/s10198-001-0090-5
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发表时间：
2002-01-01
期刊：
影响因子：
--
通讯作者：
van Gool, K
中科院分区：
文献类型：
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作者：
Bridges, J F P;Stewart, M;van Gool, K
投资组合理论是许多经济学领域风险分析的核心，但很少在卫生经济学中得到适当的应用。这一贡献探讨投资组合理论的成本效益分析（CEA）的背景下使用。一些修改是必要的，以适用于投资组合分析的经济评价的卫生保健干预措施。首先，需要修改报告成本效益分析结果的方法，从而修改一些基本假设。第二，投资组合理论需要用对总体中的个人的影响来表达。最后，需要考虑到各种卫生干预措施之间协同增效的可能性。本文推导出一个通用公式的组合卫生保健干预措施，使干预措施之间的协同作用，人口的影响是从个人的影响汇总。一些特殊的情况下，也得到突出的修改后的投资组合理论的制定的性质。我们的结论是，虽然修改后的投资组合理论增加了一个理论基础，医疗保健评估，它可能无法操作，直到干预措施之间的相关性估计是可用的，和不确定性的问题是解决在医疗保健评估。此外，虽然在个人层面可能存在协同作用，但在大量人口中聚集起来时，鉴于规模收益不变的标准假设，协同作用可能并不显著。
Portfolio theory is central to the analysis of risk in many areas of economics but is seldom used appropriately in health economics. This contribution examines the use of portfolio theory in the context of cost-effectiveness analysis (CEA). A number of modifications are needed to apply portfolio analysis to the economic evaluation of health care interventions. First, the method of reporting the results of a CEA, and consequently some of the underlying assumptions, needs to be modified. Second, portfolio theory needs to be expressed in terms of effects on individuals aggregated to a population. Finally, one needs to allow for the possibility of synergy between the various health interventions. This paper derives a general formula for a portfolio of health care interventions that allows for synergies between interventions where the population effects are aggregated from individual effects. A number of special cases are also derived to highlight the nature of the formulation of the modified portfolio theory. We conclude that, while modified portfolio theory adds a theoretical foundation to health care evaluations, it may not be operational until estimates of the correlation between interventions are available, and the question of uncertainty is resolved in health care evaluation. Also, while a synergy may be present at the individual level, when aggregated over a large population it may not be significant given the standard assumption of constant returns to scale.