{"id":392,"date":"2019-04-01T15:14:24","date_gmt":"2019-04-01T06:14:24","guid":{"rendered":"https:\/\/info.zanet.biz\/?p=392"},"modified":"2020-01-17T10:42:17","modified_gmt":"2020-01-17T01:42:17","slug":"%e5%8c%bb%e7%99%82%e7%b5%8c%e6%b8%88%e8%a9%95%e4%be%a1%e3%80%80nice%e3%81%ae%e5%a0%b4%e5%90%88","status":"publish","type":"post","link":"https:\/\/info.zanet.biz\/?p=392","title":{"rendered":"\u533b\u7642\u7d4c\u6e08\u8a55\u4fa1\u3000NICE\u306e\u5834\u5408"},"content":{"rendered":"\n<p>\u30a4\u30ae\u30ea\u30b9\u56fd\u7acb\u533b\u7642\u6280\u8853\u8a55\u4fa1\u6a5f\u69cb National Institute for Helath and Care Excellence (<a href=\"https:\/\/www.nice.org.uk\/\">NICE<\/a>)\u306f\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u3092\u4f5c\u6210\u30fb\u767a\u884c\u3057\u3066\u3044\u308b\u516c\u7684\u306a\u6a5f\u95a2\u3067\u3059\u3002\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u4f5c\u6210\u306e\u65b9\u6cd5\u30fb\u624b\u9806\u306b\u3064\u3044\u3066\u3001Developing NICE guidelines: the manual (<a href=\"https:\/\/www.nice.org.uk\/process\/pmg20\/chapter\/introduction-and-overview\">PMG20<\/a>)\u3092\u516c\u958b\u3057\u3066\u3044\u307e\u3059\u3002\u3053\u306e\u30de\u30cb\u30e5\u30a2\u30eb\u306e\u4e2d\u306e\u7b2c7\u7ae0\u30017<a href=\"https:\/\/www.nice.org.uk\/process\/pmg20\/chapter\/incorporating-economic-evaluation\"> Incorporating economic evaluation<\/a>\u304c\u533b\u7642\u7d4c\u6e08\u8a55\u4fa1\u306e\u65b9\u6cd5\u306b\u95a2\u3059\u308b\u90e8\u5206\u3067\u3059\u3002<\/p>\n\n\n\n<p>\u307e\u305a\u3001\u533b\u7642\u7d4c\u6e08\u8a55\u4fa1\u3067\u4f55\u3092\u3059\u308b\u306e\u304b\u3067\u3059\u304c\u3001&#8221;Economic evaluation compares the costs and consequences of alternative courses of action&#8221; \u300c\uff08\u533b\u7642\uff09\u7d4c\u6e08\u8a55\u4fa1\u306f\u533b\u7642\u306e\u9078\u629e\u80a2\u306e\u7d50\u679c\u3068\u8cbb\u7528\u3092\u6bd4\u8f03\u3059\u308b\u300d\u3068\u66f8\u304b\u308c\u3066\u3044\u307e\u3059\u3002\u3059\u306a\u308f\u3061\u3001\u3055\u307e\u3056\u307e\u306a\u4e88\u9632\u7684\u3001\u8a3a\u65ad\u7684\u3001\u6cbb\u7642\u7684\u4ecb\u5165\u306e\u52b9\u679c\u306b\u3064\u3044\u3066\u8cbb\u7528\u304c\u3069\u308c\u304f\u3089\u3044\u304b\u304b\u308b\u304b\u3092\u6bd4\u8f03\u3059\u308b\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002\u201d\u4e00\u5b9a\u306e\u52b9\u679c\u3092\u5f97\u308b\u306e\u306b\u3069\u308c\u3060\u3051\u8cbb\u7528\u304c\u304b\u304b\u308b\u304b\uff1f\u201d\u3001\u201d\u4eca\u307e\u3067\u306e\u6cbb\u7642\u6cd5\u3068\u6bd4\u3079\u3066\u3001\u65b0\u3057\u3044\u6cbb\u7642\u6cd5\u306f\u3088\u308a\u826f\u3044\u7d50\u679c\u3092\u5f97\u308b\u306e\u306b\u3001\u3069\u308c\u304f\u3089\u3044\u4f59\u5206\u306b\u8cbb\u7528\u304c\u304b\u304b\u308b\u304b\uff1f\u201d\u3068\u3044\u3046\u3088\u3046\u306a\u8cea\u554f\u306b\u7b54\u3048\u308b\u3082\u306e\u3067\u3059\u3002\u5f8c\u8005\u306e\u8cea\u554f\u306b\u7b54\u3048\u308b\u306e\u306b\u4f7f\u308f\u308c\u308bICER Incremental Cost-Effectiveness Ratio \u5897\u5206\u8cbb\u7528\u5bfe\u52b9\u679c\u6bd4\u3068\u3044\u3046\u4e00\u3064\u306e\u6307\u6a19\u304c\u3042\u308a\u307e\u3059\u3002Quality-Adjusted Life Years (QALYs)\u8cea\u8abf\u6574\u751f\u5b58\u5e741\u5e74\u3042\u305f\u308a\u3044\u304f\u3089\u306e\u4f59\u5206\u306a\u8cbb\u7528\u304c\u5fc5\u8981\u304b\u3068\u3044\u3046\u3053\u3068\u3092\u8868\u3059\u6307\u6a19\u3067\u3059\u3002<\/p>\n\n\n\n<p>\u3053\u306e\u7b2c7\u7ae0\u306e\u4e2d\u3067\u3001NICE\u306fICER\u306b\u95be\u5024\u3092\u8a2d\u5b9a\u3057\u305f\u3053\u3068\u306f\u306a\u3044\u3068\u3001\u8ff0\u3079\u3066\u3044\u307e\u3059\u3002\u201dNICE has never identified an ICER above which interventions should not be recommended and below which they should. However, in general, interventions with an ICER of less than \u00a320,000* per QALY gained are considered to be cost effective.\u201d\u3000\uff08*\u7d04300\u4e07\u5186\uff09<\/p>\n\n\n\n<p>NICE\u306e\u3053\u306e\u30de\u30cb\u30e5\u30a2\u30eb\u306e\u4e2d\u3067\u53d6\u308a\u4e0a\u3052\u3089\u308c\u3066\u3044\u308b\u3001\u533b\u7642\u7d4c\u6e08\u8a55\u4fa1\u306e\u624b\u6cd5\u306f\u4ee5\u4e0b\u306e\u3068\u304a\u308a\u3067\u3059\uff1a<\/p>\n\n\n\n<p class=\"has-background has-light-gray-background-color\"><strong>Cost-minimisation analylsis<\/strong>: find the least costly alternative.\u00a0 \u00a0\u00a0 \u52b9\u679c\u304c\u540c\u3058\u3068\u8a00\u3048\u308b\u9078\u629e\u80a2\u3067\u8cbb\u7528\u304c\u9078\u629e\u57fa\u6e96\u306b\u306a\u308a\u3046\u308b\u5834\u5408\u3002<br><strong>Cost-effectiveness analysis<\/strong>: monetary units vs non-monetary units (e.g., mortality or morbidity)\u00a0 \u00a0\u00a0 \u751f\u5b58\u5e74\u3001\u6b7b\u4ea1\u56de\u907f\u3001\u75c7\u72b6\u306e\u7121\u3044\u4eba\u5e74\u306a\u3069\u306b\u5bfe\u3059\u308b\u8cbb\u7528\u3002\u30a2\u30a6\u30c8\u30ab\u30e0\u3054\u3068\u306b\u5206\u3051\u3066\u691c\u8a0e\u306f\u3057\u306a\u3044\u3002<br><strong>Cost-utility analysis<\/strong>: monetary units vs utility (QALYs).\u00a0 \u00a0\u00a0 Cost-effectiveness analysis\u306e\u4e2d\u3067\u3001Utility\u52b9\u7528\u5024\u3092\u5171\u901a\u306e\u30a2\u30a6\u30c8\u30ab\u30e0\u3068\u3057\u3066\u7528\u3044\u308b\u65b9\u6cd5\u3002QALYs\u3092\u7528\u3044\u3066\u3001\u7570\u306a\u308b\u30dd\u30d4\u30e5\u30ec\u30fc\u30b7\u30e7\u30f3\u7570\u306a\u308b\u5730\u57df\u306e\u9593\u306e\u6bd4\u8f03\u304c\u53ef\u80fd\u3002<br><strong>Cost-consequences analylsis<\/strong>: costs and outcomes without aggregating or weighting.\u00a0 \u00a0\u00a0 \u30a2\u30a6\u30c8\u30ab\u30e0\u3092Utility\u52b9\u7528\u5024\u3067\u8868\u3059\u3053\u3068\u304c\u3067\u304d\u306a\u3044\u5834\u5408\u3001\u9069\u7528\u3092\u8003\u3048\u308b\u3002\u7570\u306a\u308b\u30a2\u30a6\u30c8\u30ab\u30e0\u3092\u4e00\u3064\u306e\u5024\u306b\u307e\u3068\u3081\u308b\u3053\u3068\u304c\u3067\u304d\u306a\u3044\u5834\u5408\u306b\u6709\u7528\u3067\u3042\u308b\u3002<br><strong>Cost-benefit analylsis<\/strong>: costs and benefits in common monetary terms.\u00a0 \u00a0\u00a0 \u5065\u5eb7\u30a2\u30a6\u30c8\u30ab\u30e0\u3001\u305d\u308c\u4ee5\u5916\u306e\u30a2\u30a6\u30c8\u30ab\u30e0\u3092\u91d1\u92ad\u7684\u4fa1\u5024\u306b\u63db\u7b97\u3057\u3066\u8cbb\u7528\u3068\u6bd4\u8f03\u3059\u308b\u3002<br><br>*\u65e5\u672c\u8a9e\u3067\u306f\u3001\u8cbb\u7528\u6700\u5c0f\u5316\u5206\u6790\u3001\u8cbb\u7528\u5bfe\u52b9\u679c\u5206\u6790\u3001\u8cbb\u7528\u5bfe\u52b9\u7528\u5206\u6790\u3001\u8cbb\u7528\u5bfe\u7d50\u679c\u5206\u6790\u3001\u8cbb\u7528\u5bfe\u4fbf\u76ca\u5206\u6790\u306a\u3069\u3002\u201d\u5bfe\u201d\u304c\u306a\u3044\u5834\u5408\u3001-\u3084\/\u304c\u4f7f\u308f\u308c\u3066\u3044\u308b\u5834\u5408\u3082\u3042\u308a\u3002NICE\u306f\u8cbb\u7528\u5bfe\u52b9\u7528\u5206\u6790\u3092\u91cd\u8996\u3057\u3066\u3044\u308b\u3088\u3046\u3067\u3059\u3002<\/p>\n\n\n\n<p><a href=\"https:\/\/www.nice.org.uk\/process\/pmg20\/resources\/appendix-h-pdf-2549710190\">Appendix H<\/a>\u306b\u306fAppraisal checklists: economic evaluations\u304c\u542b\u307e\u308c\u3066\u304a\u308a\u3001\u4ee5\u4e0b\u306e\u901a\u308a\u3067\u3059\u3002\u65e2\u5b58\u306e\u533b\u7642\u7d4c\u6e08\u8a55\u4fa1\u306e\u8ad6\u6587\u3092\u8a55\u4fa1\u3059\u308b\u969b\u306b\u7528\u3044\u308b\u3082\u306e\u3067\u3001\u307e\u305aSection 1\u3067\u9069\u7528\u53ef\u80fd\u6027\u3092\u8a55\u4fa1\u3057\u3001\u9069\u7528\u53ef\u80fd\u3068\u5224\u65ad\u3055\u308c\u308c\u3070\u3001Section 2\u3067\u7814\u7a76\u306e\u9650\u754c\u3059\u306a\u308f\u3061\u65b9\u6cd5\u8ad6\u7684\u8cea\u3092\u8a55\u4fa1\u3057\u307e\u3059\u3002<\/p>\n\n\n\n<p class=\"has-background has-light-gray-background-color\">Section 1: Applicability    Yes\/partly\/no\/unlcear\/NA   Comments<br> 1.1 Is the study <strong>population<\/strong> appropriate for the review question?<br> 1.2 Are the<strong> interventions<\/strong> appropriate for the review question?<br> 1.3 Is the <strong>system<\/strong> in wich the study was conducted sufficiently similar to the current UK context?<br> 1.4 Is the <strong>perspective for costs<\/strong> appropriate for the review question?<br> 1.5 Is the<strong> perspective for outcomes<\/strong> appropriate for the review question?<br> 1.6 Are all future costs and outcomes<strong> discounted <\/strong>appropriately?<br> 1.7 Are<strong> QALYs<\/strong>, derived using NICE&#8217;s preferred methods, or an appropriate social care-related equivalent used as an outcome? If not, describe<strong> rationale<\/strong> and outcomes used in line with analytical perspectives taken (item 1.5 above).<br> 1.8 Overall judgement: Directly applicable\/partially applicable\/not applicable<\/p>\n\n\n\n<p class=\"has-background has-light-gray-background-color\">Section 2: Study limitations (the level of methodological quality)     Yes\/partly\/no\/unlcear\/NA   Comments<br> 2.1 Does the <strong>model <\/strong>structure adequately reflect the nature of the topic under evaluation?<br> 2.2 Is the <strong>time horizon<\/strong> sufficiently long to reflect all important dirrerences in costs and outcomes?<br> 2.3 Are all impportant and relevant <strong>outcomes<\/strong> included?<br> 2.4 Are the estimates of <strong>baseline outcomes<\/strong> from the best available source?<br> 2.5 Are the<strong> estimates of relative intervention effects<\/strong> from the best available source?<br> 2.6 Are all important and relevant<strong> costs <\/strong>included?<br> 2.7 Are the<strong> estimates of resource use<\/strong> from the best available source?<br> 2.8 Are the <strong>unit costs<\/strong> of resources from the best available source?<br> 2.9 Is an appropriate<strong> incremental analysis <\/strong>presented or can it be calculated from the data?<br> 2.10 Are all important parameters whose values are uncertain subjected to appropriate <strong>sensitivity analysis<\/strong>?<br> 2.11 Has no potential financial <strong>conflict of interest<\/strong> been declared?<br> 2.12 Overall assessment: Minor limitations\/potentially serious limitations\/very serious lilmitations<\/p>\n\n\n\n<p>\u305d\u306e\u4ed6\u91cd\u8981\u3068\u601d\u3063\u305f\u70b9\u3092\u30ea\u30b9\u30c8\u30a2\u30c3\u30d7\u3057\u3066\u304a\u304d\u307e\u3059\u3002<\/p>\n\n\n\n<p>\u2605\u30af\u30ea\u30cb\u30ab\u30eb\u30af\u30a8\u30b9\u30c1\u30e7\u30f3\u3068\u95a2\u9023\u4ed8\u3051\u3066\u30b3\u30f3\u30bb\u30d7\u30c8\u30e2\u30c7\u30eb\u3092\u4f5c\u308b\u3002<br>\u2605\u5bfe\u8c61\u60a3\u8005\u306b\u5bfe\u3059\u308b\u3059\u3079\u3066\u306e\u4ecb\u5165\u3001\u533b\u7642\u30b5\u30fc\u30d3\u30b9\u3092\u6bd4\u8f03\u3059\u308b<br>\u2606\u8cea\u306e\u9ad8\u3044\u30a8\u30d3\u30c7\u30f3\u30b9\u306b\u57fa\u3065\u304f\u30e2\u30c7\u30eb\u306e\u69cb\u9020\u3092\u7528\u3044\u308b\u3002<br>\u2605\u533b\u7642\u7d4c\u6e08\u30e2\u30c7\u30eb\u306b\u3064\u3044\u3066\u306f\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u4f5c\u6210\u306e\u521d\u671f\u6bb5\u968e\u304b\u3089\u8b70\u8ad6\u3057\u540c\u610f\u3092\u56f3\u308b\u3002\u2606\u8cc7\u6e90\u306e\u5236\u9650\u306f\u91d1\u92ad\u7684\u3001\u30b9\u30bf\u30c3\u30d5\u3001\u5165\u9662\u30d9\u30c3\u30c9\u3001\u88c5\u7f6e\u306a\u3069\u3059\u3079\u3066\u3092\u542b\u3080\u3002<br>\u2605\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u4f5c\u6210\u30b0\u30eb\u30fc\u30d7\u3067\u306e\u691c\u8a0e\u306b\u5148\u7acb\u3061\u8cea\u4fdd\u8a3c\u306e\u30d7\u30ed\u30bb\u30b9\u3092\u7f6e\u304f\uff1aone-way, n-way, \u78ba\u7387\u7684\u611f\u5ea6\u5206\u6790\u3001\u7d50\u679c\u304c\u8aac\u660e\u53ef\u80fd\u3067\u3042\u308b\u3053\u3068\u3092\u78ba\u8a8d\u3001\u4e2d\u9593\u30a8\u30f3\u30c9\u30dd\u30a4\u30f3\u30c8\u3068\u6700\u7d42\u30a8\u30f3\u30c9\u30dd\u30a4\u30f3\u30c8\u306e\u95a2\u4fc2\u3092\u78ba\u8a8d\u3059\u308b\u306a\u3069\u3002<br>\u2606\u5916\u7684\u59a5\u5f53\u6027\u306e\u89e3\u6790\u304c\u53ef\u80fd\u306a\u5834\u5408\u306f\u5b9f\u884c\u3059\u3079\u304d\u3002<br>\u2606\u751f\u5b58\u5e74\u3001\u30a4\u30d9\u30f3\u30c8\u6570\u3001\u751f\u5b58\u306e\u3088\u3046\u306a\u30a8\u30f3\u30c9\u30dd\u30a4\u30f3\u30c8\u3092\u63d0\u793a\u3059\u308b\u3002<br>\u2606\u8cbb\u7528\u306e\u5185\u8a33\u3092\u63d0\u793a\u3059\u308b\u3002<br>\u2606\u5168\u8cbb\u7528\u3068\u5897\u5206\u8cbb\u7528\u3068\u52b9\u679c\u3092\u3059\u3079\u3066\u306e\u9078\u629e\u80a2\u306b\u3064\u3044\u3066\u63d0\u793a\u3059\u308b\u3002<br>\u2606\u591a\u304f\u306e\u9078\u629e\u80a2\u3092\u6bd4\u8f03\u3059\u308b\u5834\u5408\u306f\u8cbb\u7528\u3042\u308b\u3044\u306f\u30a2\u30a6\u30c8\u30ab\u30e0\u3067\u9806\u4f4d\u3092\u4ed8\u3051\u3001\u9806\u756a\u306b\u5897\u5206\u52b9\u679c\u30fb\u5897\u5206\u8cbb\u7528\u3092\u6bd4\u8f03\u3059\u308b\u3053\u3068\u3002<br>\u2606\u9593\u63a5\u7684\u6bd4\u8f03\uff08Network meta-analsysis\u306e\u3088\u3046\u306a\uff09\u306e\u5834\u5408\u306f\u3001\u9650\u754c\u3092\u660e\u78ba\u306b\u3059\u308b\u3053\u3068\u3002<br>\u2605\u533b\u7642\u7d4c\u6e08\u30e2\u30c7\u30eb\u306f\u5229\u5bb3\u95a2\u4fc2\u8005\u306b\u958b\u767a\u6bb5\u968e\u304b\u3089\u516c\u958b\u3059\u308b\u3053\u3068\u3002<br><br>\u2606\u5065\u5eb7\u52b9\u679c\u306e\u6e2c\u5b9a\u30fb\u4fa1\u5024\u3065\u3051\u306b\u306fQALYs\u3092\u7528\u3044\u3001\u5065\u5eb7\u95a2\u9023QOL\u306e\u6e2c\u5b9a\u306b\u306f<a href=\"https:\/\/www.nice.org.uk\/about\/what-we-do\/our-programmes\/nice-guidance\/technology-appraisal-guidance\/eq-5d-5l\">EQ-5D<\/a>\u304c\u597d\u307e\u3057\u3044\u3002<br><br>\u2605\u6c7a\u5b9a\u6728Decision tree\u3001\u30de\u30eb\u30b3\u30d5\u30e2\u30c7\u30ebMarkov model\u3001Discrete event simulation\u306a\u3069\u306e\u65b9\u6cd5\u3092\u7528\u3044\u308b\u3002<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u30a4\u30ae\u30ea\u30b9\u56fd\u7acb\u533b\u7642\u6280\u8853\u8a55\u4fa1\u6a5f\u69cb National Institute for Helath and Care Excellence (NICE)\u306f\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u3092\u4f5c\u6210\u30fb\u767a\u884c\u3057\u3066\u3044\u308b\u516c\u7684\u306a\u6a5f\u95a2\u3067\u3059\u3002\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u4f5c\u6210\u306e\u65b9 &hellip; <a href=\"https:\/\/info.zanet.biz\/?p=392\" class=\"more-link\"><span class=\"screen-reader-text\">&#8220;\u533b\u7642\u7d4c\u6e08\u8a55\u4fa1\u3000NICE\u306e\u5834\u5408&#8221; \u306e<\/span>\u7d9a\u304d\u3092\u8aad\u3080<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[],"class_list":["post-392","post","type-post","status-publish","format-standard","hentry","category-cea"],"_links":{"self":[{"href":"https:\/\/info.zanet.biz\/index.php?rest_route=\/wp\/v2\/posts\/392","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/info.zanet.biz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/info.zanet.biz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/info.zanet.biz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/info.zanet.biz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=392"}],"version-history":[{"count":5,"href":"https:\/\/info.zanet.biz\/index.php?rest_route=\/wp\/v2\/posts\/392\/revisions"}],"predecessor-version":[{"id":791,"href":"https:\/\/info.zanet.biz\/index.php?rest_route=\/wp\/v2\/posts\/392\/revisions\/791"}],"wp:attachment":[{"href":"https:\/\/info.zanet.biz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=392"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/info.zanet.biz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=392"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/info.zanet.biz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=392"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}