３． 薬剤経済評価のための患者アウトカム評価

抄録

With the decline in economic growth and increase in the aging population, rational allocation of medical resources has become more important. To construct more effective and efficient medical systems, health-related quality of life (HRQOL) is used not only for evaluating patients' HRQOL, but also for reflecting people's preference to medical resource allocation. In this review article, first we explain HRQOL, especially for cancer patients. Second we focus on the cost-effectiveness of expensive anti-cancer drugs. In addition, to support decision-making based on economic evaluation, we discuss the threshold of cost-effectiveness analysis; how the criteria on cost-effectiveness should be determined.
In the first part of this review article, we explain the concept of HRQOL, which is multi-dimensional, consisting of, for example, physical, mental and social domains. HRQOL is classified into profile and index types. The latter is mainly used for economic evaluation to calculate quality-adjusted life years (QALYs). Cost per QALY is a standard indicator to compare the efficiency of medicine or medical intervention. In the second part, we discuss the cost-effectiveness of expensive anti-cancer drugs called molecular targeting drugs. Some of them have been judged to be not cost-effective by, for example, NICE (The National Institute for Health and Clinical Excellence) in UK and other studies. We discuss how such expensive drugs should be dealt with in the context of public health insurance and taxation. Finally we propose that the threshold of cost-effective analysis should be from JPY 5.0 million to JPY 6.0 million based on our international willingness-to-pay (WTP) survey.