VALUE MEASUREMENT IN CEA: FAIRNESS TO ELDERLY/DISABLED

描述（改编自摘要）：成本效益分析（CEA） 被批评歧视残疾人， 伤害老年人，忽视公平问题，低估 有利于治疗重症患者。 因为老年人往往有 慢性残疾限制了他们提高生活质量的能力。 生活与健康计划，计划成本效益的措施 针对老年人的，似乎相对不利。 我们认为 这些问题可以通过区分与健康有关的 医疗保健项目带来的效用和这些项目的社会价值 程序. 其目标是改进CEA中的价值计量，使其对 老年人和残疾人。 为了实现这一目标，我们计划 测试和完善人的权衡方法（PTO）-一个衡量社会 保健计划的价值。 在典型的PTO启发中，主题是 询问有多少人需要治愈健康状况（例如，严重 骨关节炎），以等于挽救十人的生命的好处。 几 关于PTO测量的可行性出现了方法学问题。 在 一系列的六项研究，我们将探讨这些方法论问题，以及 人们对PTO激发做出反应时的认知过程。 该小组建议从公众进行PTO eliciatations使用 面对面的面试。 受试者的主要来源将是前瞻性的 费城县法院和蒙哥马利县法院的陪审员 来自特拉华州山谷地区的顾客。 研究1和2将探讨如何 提高PTO响应的一致性。 研究3将探索社会 重视人们对预防性和治疗性治疗项目的看法。 研究4 将评估CEA是否低估了旨在挽救生命的治疗计划 慢性残疾人的生活。 研究5将测试 人们在回应PTO请求时过于重视公平， 受框架效应导致的认知偏差的影响。 研究6将 探索人们对治疗计划的价值是否取决于 患者的年龄，以及他们对年龄的重视程度是否因年龄而异 治疗程序（例如，拯救生命的计划与改善 功能或减轻疼痛）。 目标是评估PTO决定是否 可以有效地解决传统的 效用评估适用于评估卫生保健计划， 老年人和残疾人。

DESCRIPTION (adapted from the Abstract): Cost-effectiveness analysis (CEA) has been criticized for discriminating against people with disabilities, for harming the elderly, for ignoring issues of fairness, and for undervaluing the benefit of treating severely ill patients. Because the elderly often have chronic disabilities that limit the amount they can improve their quality of life with health programs, measures of the cost-effectiveness of programs targeted toward the elderly appear relatively unfavorable. We think that these problems can be overcome by distinguishing between the health related utility brought by health care programs and the societal value of those programs. The goal is to improve value measurement in CEA to make it fair to the elderly and people with disabilities. To achieve this goal, we plan to test and refine the person trade-off method (PTO) - a measure of the societal value of health care programs. In a typical PTO elicitation, a subject is asked how many people need to be cured of a health condition (e.g., severe osteoarthritis) to equal the benefit of saving ten people's lives. Several methodologic issues have arisen about the feasibility of PTO measurement. In a series of six studies, we will explore these methodologic issues as well as the cognitive processes people undergo when responding to PTO elicitations. The team proposes to conduct PTO eliciatations from the general public using face to face interviews. The primary source of subjects will be prospective jurors at the Philadelphia County and Montgomery County Courthouses and mall patrons from the Delaware Valley area. Studies 1 and 2 will explore way to improve the consistency of PTO responses. Study 3 will explore the societal value people place on preventive versus curative treatment programs. Study 4 will evaluate whether CEA undervalues treatment programs directed at saving the lives of people with chronic disabilities. Study 5 will test whether the importance people place on equity in responding to PTO elicitations is unduly influenced by cognitive biases resulting from framing effects. Study 6 will explore whether the value people place on treatment programs depends on patients' ages, and whether the importance they place on age varies across treatment programs (e.g., life saving programs versus programs that improve function or reduce pain). The goal is to evaluate whether PTO determinations can be an effective solution to the problems that arise when conventional utility assessment is applied to the evaluation of health care programs for the elderly and disabled.