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首页> 外文期刊>Journal of health politics, policy and law >Role of budget impact in drug reimbursement decisions.
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Role of budget impact in drug reimbursement decisions.

机译：预算影响在药物报销决策中的作用。

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There are three known criteria that underlie drug reimbursement decisions: therapeutic value, cost-effectiveness, and burden of disease. However, evidence from recent reimbursement decisions in several jurisdictions points to residual, unexplained variables, among which is budget impact. Budget impact refers to the total costs that drug reimbursement and use entail with respect to one part of the health care system, pharmaceutical care, or to the entire health care system, taking into account the possible reallocation of resources across budgets or sectors of the health care system. The economic and equity rationale for carrying out budget impact analyses is opportunity cost, or benefits forgone, measured in terms of utility or equitable distribution, by using resources in one way rather than another. In other words, by choosing to draw down the budget in one way, decision makers forgo other opportunities to use the same resources. Under a set of unrealistic assumptions, cost-effectiveness analysis accounts for opportunity cost while conveying to the decision maker the price of maximizing health gains, subject to a budget or resource constraint. However, the underlying assumptions are implausible, particularly in the context of pharmaceutical care. Moreover, budget impact analysis is more useful to the decision maker than cost-effectiveness analysis if the objective is not to maximize health gains subject to a budget or resource constraint, but to reduce variance in health gains. With respect to equitable distribution, budget impact analyses lay bare the individuals or groups who lose out - those who bear the opportunity cost of spending resources in accordance with one decision rule rather than another.
机译：决定药物报销的依据是三个已知标准：治疗价值，成本效益和疾病负担。但是，一些司法管辖区最近的报销决定提供的证据表明，尚有无法解释的剩余变量，其中包括预算影响。预算影响是指考虑到整个预算或卫生部门可能重新分配资源的情况，药物报销和使用对医疗保健系统的一部分，药物保健或整个医疗保健系统造成的总成本。护理系统。进行预算影响分析的经济和公平理由是机会成本或放弃的收益，以效用或公平分配的方式衡量，通过一种方式而不是另一种方式使用资源。换句话说，通过选择以一种方式减少预算，决策者放弃了使用相同资源的其他机会。在一组不切实际的假设下，成本效益分析会考虑机会成本，同时会在预算或资源约束下，向决策者传达使健康收益最大化的价格。但是，这些基本假设是不合理的，尤其是在药物护理方面。此外，如果目标不是要在预算或资源约束下最大化健康收益，而是减少健康收益的差异，则预算影响分析对决策者比成本效益分析更有用。关于公平分配，预算影响分析使失败的个人或群体暴露出来-那些承担根据一项决策规则而不是另一项决策规则花费资源的机会成本的人或群体。

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