摘要
目的:评估低价值医疗服务的风险。方法:基于文献回顾和四川省2016—2020年病案首页数据,构建低价值子宫切除术的风险评估指标,从全社会、患者、卫生体系和支付方四个角度构建决策树模型并进行成本-效果分析。结果:低价值子宫切除术提供比例为17.8%,其健康临床风险、健康人文风险和健康经济风险均高于替代服务,从全社会和患者角度看,低价值子宫切除术属于高成本、低效果服务;从卫生体系和支付方角度看,低价值子宫切除术属于低成本、低效果服务;成本-效果分析显示,以有效率和并发症发生情况为产出,低价值子宫切除术的经济性较差。结论:低价值子宫切除术具有较高风险,风险程度因成本测算角度不同而存在差异,需要进一步扩充低价值医疗服务的证据,从而制定更加科学全面的临床指南和政策。
Objective To assess the risk of low-value care in China.Methods Through literature review and hospital discharge records related to hysterectomy from 2016 to 2020 in Sichuan Province,key indicators of risk assessment for low-value care were constructed.Decision tree models were developed for cost-effectiveness analysis from four perspectives:the whole society,patients,healthcare system,and payers.Results The proportion of low-value hysterectomy episodes was 17.8%.Clinical risks,humanistic risks,and economic risks of low-value hysterectomy were all higher than those of alternative services.Low-value hysterectomy was considered a high-cost,low-efficiency service from the perspectives of the whole society and patients,while it was considered a low-cost,low-efficiency service from the perspectives of the healthcare system and payers.Besides,the cost-effectiveness analysis indicated that the economy of low-value hysterectomy was poor based on efficiency and complication occurrence as outputs.Conclusion Low-value hysterectomy poses higher risk and its direction and magnitude may vary under different cost assessment perspectives.It is necessary to further strengthen and expand the evidence base for low-value care to develop more scientific and comprehensive clinical guidelines and policies.
作者
罗慧佳
蓝天骄
潘杰
LUO Huijia;LAN Tianjiao;PAN Jie(West China School of Public Health and West China Fourth Hospital,Sichuan University,Chengdu Sichuan 610041,China;不详)
基金
国家自然科学基金项目“社会办医发展影响评估及政策优化研究:基于全国机构和个人层面数据的多角度分析”(72074163),“地区间医疗费用差异的成因分析及应对策略研究”(72374149)
四川省科技计划项目“基于病原学‘多点触发’的重大传染病研判关键技术及流行预警模型的研究”(2022YFS0052)。
