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首页> 外文期刊>Journal of health services research & policy >Is the aim of the English health care system to maximize QALYs?
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Is the aim of the English health care system to maximize QALYs?

机译：英国医疗保健系统的目标是最大化QALY吗？

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Objectives: To compare the types of benefit considered relevant by the English Department of Health with those included by the National Institute for Health and Clinical Excellence (NICE) when conducting economic evaluations of options for spending limited health care resources. Methods:We analysed all policy Impact Assessments (IAs) carried out by the Department ofHealth (DH) in 2008 and 2009. The stated benefits of each policy were extracted and thematic analysis was used to categorise these. Results: 51 Impact Assessments were analysed, eight of which mentioned quality-adjusted life year (QALY) gains as a benefit. 18 benefits other than QALY gains were identified. Apart from improving health outcomes, commonly referred to benefits included: reducing costs, improving quality of care, and enhancing patient experience. Many of the policies reviewed were implemented on the basis of benefits unrelated to health outcome. The methods being used to apply a monetary valuation to QALY gains (in cost-benefit calculations) are not consistent across Impact Assessments or with NICE's stated threshold range. Conclusions: The Department of Health and NICE approach resource allocation decisions in different ways, based upon overlapping but not congruent considerations and underlying principles. Given that all these decisions affect the allocation of the same fixed health care budget, there is a case for establishing a uniform framework for option appraisal and priority setting so as to avoid allocative inefficiency. The same applies to any other national health care system.
机译：目标：在对花费有限的医疗资源进行选择的经济评估时，比较英国卫生部认为与美国国家卫生与临床卓越研究所（NICE）包括的福利类型有关。方法：我们分析了卫生部（DH）在2008年和2009年进行的所有政策影响评估（IAs）。提取了每个政策的规定收益，并使用主题分析对其进行了分类。结果：分析了51项影响评估，其中有八项提到了质量调整生命年（QALY）收益。除了QALY收益外，还确定了18种收益。除了改善健康状况外，通常提到的好处还包括：降低成本，改善护理质量以及增强患者体验。审查的许多政策都是在与健康结果无关的利益的基础上实施的。在影响评估或NICE规定的阈值范围内，用于将货币估值应用于QALY收益（在成本效益计算中）的方法不一致。结论：卫生部和NICE基于重叠但并非一致的考虑因素和基本原则，以不同的方式处理资源分配决策。鉴于所有这些决定都会影响同一固定医疗预算的分配，因此有必要建立一个统一的期权评估和优先级确定框架，以避免分配效率低下。这同样适用于任何其他国家卫生保健系统。

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