Health Technology Assessment and Justice

(Scarcity)Scarcity is the fundamental economic problem of having seemingly unlimited human needs and wants, in a world of limited resources. Trade-offs are inevitable.

(need)(contribution)(status)(talent)(equality)(lottery)(first-come, first-served)(ability to pay)

(2007).

Persad et al. Principles for allocation of scarce medical interventions (2009).

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(Health Technology Assessment, HTA)INAHTA(International Network of Agencies for Health Technology Assessment) 2009

(Pharmacoeconomics)(Health economics)

Cost-benefit analysis (CBA)Cost-effectiveness analysis (CEA)(life-years gained, LYG)Cost-utility analysis (CUA)(quality adjusted life-years, QALYs)

1992 (National Institute for Health and Clinical Excellence, NICE)NICENational Health Service (NHS)

HTA200020052007220114142HTA

+10%3(2)(PE)10%

HTA20069AMCP200612

(ICER)(Incremental Cost-Effectiveness Ratio)The ratio of the change in costs of a therapeutic intervention to the change in effects of the intervention.A200B100A3B2AICER100

Eichler et al. (2004)2002US$17,600/QALYUS$87,800/QALY2002US$28,200/LYGUS$51,000/LYGUS$10,900/QALY2002US$32,000/QALYUS$48,000/QALY

WHO Threshold value-World Health Organization, World Health Report 2002DALYs for a disease or health condition are calculated as the sum of the Years of Life Lost (YLL) due to premature mortality in the population and the Years Lost due to Disability (YLD) for incident cases of the health condition:DALYYLL+YLD

99858173Vidaza for Injectable Suspension (azacitidine 100mg/vial, B025154255)AZA-001azacitidinecytarabineintensive cytarabine(24.5vs.15)17~2023ICER

999981820Avastin Injection 25mg/mL, 4mL (bevacizumab, K000807219)The National Institute for Health and Clinical Excellence (NICE) 2010820,800100NICE

991078196sorafenib (:Nexavar) 2009Lancet Oncologysorafenib2.3(6.5 vs. 4.2, HR=0.68, 95% CI=0.50-0.93)1310991228219cetuximabErbitux1 4

Threshold of ICERJan Vermeer (1664)