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目的:进行成本-效果分析(Cost-effectiveness Analysis,CEA)时,为保证评价的一致性和可比性,多数涉及到CEA的指南均建议使用应用普遍、广泛的社会角度。作为工作组的子报告[来自成本-效果分析中药物成本测量的良好研究规范(ISPOR药物成本工作组;Drug Cost Task Force,DCTF)的六份报告之一],本文旨在回顾社会角度的定义,评估其在成本测量中的特定应用,识别其在理论和实践中的局限性,并就潜在的改进提出建议。方法:对有关方法学介绍的重要文献、书籍与报告进行全面的回顾、总结,并整合成为综述及报告草案。将报告草案寄送至ISPOR并由ISPOR成员审阅和评论。根据接收到的大量评论和建议,对报告草案进行相应修订。结果:可从以下三方面对社会角度进行界定:(1)时间成本的纳入;(2)机会成本的使用;(3)集体偏好。实际上虽然许多已公开发表的CEA声称使用了社会角度,但即使有也只有很少部分CEA能够满足上述所有条件。品牌药的成本多采用仅反映短期生产和配送成本的实际购买成本,而非更低的社会机会成本。这种做法对于当前的决策者而言是可以理解且务实、有用的。然而这种CEA的应用注重了静态而非动态效率,忽视了对创新的相关激励。结论:我们的首要建议是,当前CEA评价实践应通过采用参照方案的新标准作为一种“有限的社会角度”或“卫生体系”角度,并在考虑到间接成本和集体偏好的情况下使用药物获得成本,以此来承认并接受这种局限性。当涉及研发成本及创新激励等重要议题时,药物经济学领域也必须承认这种研究角度的局限性。
OBJECTIVE: To ensure the consistency and comparability of assessments when conducting cost-effectiveness analysis (CEA), most guidelines concerning CEA recommend the use of a universal and broad social perspective. As a sub-report of the working group [one of six reports from Good Cost Practices for Cost-Effectiveness Analysis (ISPOR Drug Cost Task Force, DCTF)], the purpose of this paper is to review the definition of social perspective , Evaluate its specific application in cost measurement, identify its limitations in theory and practice, and make recommendations for potential improvements. Methods: A comprehensive review and summary of important literature, books and reports on methodological introduction was made and integrated into a review and draft report. Send the draft report to ISPOR and review and comment by ISPOR members. Based on the large number of comments and suggestions received, the draft report was revised accordingly. Results: The social perspective can be defined from the following three aspects: (1) the inclusion of time cost; (2) the use of opportunity cost; (3) the collective preference. In fact, while many publicly available CEAs claim to use a social perspective, very few, if any, CEA addresses all these conditions. The cost of branded medicines is more than the actual cost of purchasing that reflects only short-term production and distribution costs, not the lower social opportunity costs. This approach is understandable and pragmatic and useful to current policy makers. However, this CEA application focuses on static rather than dynamic efficiency, ignoring the relevant incentives for innovation. CONCLUSIONS: Our first recommendation is that current CEA evaluation practices should be guided by the adoption of new standards of reference programs as a “limited social perspective” or “health system” perspective, taking into account the indirect costs and collective preferences Use of drugs in the case of cost, in order to recognize and accept this limitation. When it comes to important topics such as R & D costs and innovation incentives, the field of pharmacoeconomics must also recognize the limitations of this research perspective.