VALUE MEASUREMENT IN CEA: FAIRNESS TO ELDERLY/DISABLED

说明(摘自摘要)：成本效益分析(CEA)有 因歧视残疾人而受到批评， 伤害老年人，忽视公平问题，低估 治疗重病患者的好处。因为老年人经常会有 慢性残疾限制了他们可以提高其质量的数量 生命与健康方案，方案成本效益的衡量标准 以老年人为目标似乎相对不利。我们认为 这些问题可以通过区分与健康相关的 医疗保健项目带来的效用以及这些项目的社会价值 程序。目标是改进CEA的价值衡量，使其公平 老年人和残疾人。为了实现这一目标，我们计划 测试和改进个人权衡方法(PTO)--一种衡量社会 医疗保健计划的价值。在典型的PTO启发中，受试者是 询问需要治愈多少人的健康状况(例如，严重 骨关节炎)相当于挽救十个人的生命。几个 关于PTO测量的可行性，已经出现了方法学问题。在……里面 一系列六项研究，我们将探索这些方法论问题以及 人们在对PTO刺激作出反应时所经历的认知过程。 该小组建议通过以下方式向公众进行PTO启发： 面对面的采访。主题的主要来源将是预期的 费城和蒙哥马利县法院和购物中心的陪审员 特拉华河谷地区的赞助人。研究1和研究2将探索如何 提高PTO反应的一致性。研究3将探索社会 重视人们对预防治疗计划的重视。研究4 将评估CEA是否低估了旨在节省资金的治疗计划 慢性残障人士的生活。研究5将测试是否 人们在应对PTO引发时过于重视公平 受框架效应导致的认知偏差的影响。研究6将 探索人们对治疗方案的重视是否取决于 患者的年龄，以及他们对年龄的重视程度是否有所不同 治疗方案(例如，救命方案与改善方案 功能或减轻疼痛)。目标是评估PTO的确定是否 可以有效地解决传统方法中出现的问题 效用评估被应用于卫生保健计划的评估 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.