基于EVIDEM的新技术医保报销循证决策框架探析

摘要

This study aimed to establish a new technology for health insurance reimbursement evidence-based decision-making framework on the basis of EVIDEM. Literature review,focus group discussion and qualitative inter-view were used to construct the preliminary decision-making framework,and expert consultation was adopted to deter-mine the necessity and weight of the criteria. The established evidence-based decision-making framework consists of guidelines of normative universal and contextual aspects. The normative aspect included following criteria, need for intervention (i.e. disease severity, size of affected population, benefit type of technology, unmet needs of reim-bursed technology),comparative outcomes of technology (i.e. comparative effectiveness,comparative safety/tolera-bility,comparative patient-perceived/patient-reported outcomes), and economic consequences of technology (i.e. cost,results of economic evaluation). The contextual aspect reflects the mission and mandate of medical insurance, population priorities and the accessibility,common goal and specific interests, political context, and affordability of medical insurance.%基于EVIDEM构建新技术的医保报销循证决策框架.采用文献分析、专题小组讨论和定性访谈初步构建决策框架,通过专家咨询确定准则的必要性和权重.建立的循证决策框架由通用准则和情景化准则组成.其中,通用准则包括技术的需要(疾病的严重程度、影响的人群范围、技术的益处类型、已报销技术未满足的要求)、技术的比较结果(相对有效性、相对安全性/耐受性、患者感知/报告结果)和技术的经济性(技术成本、成本效果、经济学评价的结果);情景化准则体现了医保的使命和任务、优先重点人群和可及性、共同目标和特定利益、政策背景以及医保基金的可承受性.