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기회비용 기반 임계값 추정 연구에 대한 체계적 문헌고찰
홍지형 ( Jihyung Hong ),배은영 ( Eun-young Bae ) 한국보건경제정책학회 2022 보건경제와 정책연구 Vol.28 No.2
새로운 의료기술의 비용-효과성을 판단하기 위해서는 일반적으로 임계값이 필요하다. 임계값이 무엇을 반영해야 하는지에 대해 아직 합의된 의견은 없으나, 일반적으로 건강 한 단위에 대해 사회가 부여한 한계가치를 반영해야 한다는 수요 측면의 접근과 새로운 기술 도입으로 인해 발생하는 기회비용을 반영해야 한다는 공급 측면의 접근이 있다. 지금까지는 대체로 수요 측면의 관점에서 임계값을 논의하거나 실증적으로 분석하였을 뿐 기회비용 관점은 크게 주목받지 못하였다. 본 연구에서는 체계적 문헌고찰을 통해 기회비용 기반 임계값 추정 연구의 현황과 방법론에 대해 자세히 고찰하였다. 주요 데이터베이스와 검색어를 활용하여 최종적으로 총 17개의 연구를 선별하였는데, 이 중 14개가 국가별 분석을 수행하였다. 이들은 기회비용 기반 임계값을 추정하기 위해 대체로 보건의료체계 내에서 생산된 건강 한 단위당 한계비용을 산출하였다. 임계값 추정치는 미국과 북유럽 국가보다는 중국과 콜롬비아 등의 상위 중간소득 국가와 영국과 호주에서 상대적으로 낮게 나타났는데, 이는 대체로 1인당 GDP에 못 미치는 수준이었다. 아직 우리나라에서는 이러한 연구가 수행된 바 없어 의사결정의 기회비용을 가늠하기 어렵다. 초고가 의약품이나 의료기술이 점차 늘어나고 있는 현 상황에서 이러한 도입 정의 기회비용이나 전체 보건의료예산을 제대로 고려하지 않는다면 이는 자칫 총 건강 감소 및 재정 건전성 악화로 이어질 수도 있다. 자원 배분의 합리적 의사결정을 위해서는 건강에 대한 사회적 선호와 지불의사뿐만 아니라 보건의료에 할당된 예산 수준과 의사결정의 기회비용을 함께 고려할 필요가 있다. 기회비용 기반 임계값 추정 연구가 조속히 추진될 수 있도록 이 연구에서는 추가로 임계값 추정 시 고려해야 할 여러 방법론적 고려사항이나 쟁점들에 대해 자세히 논의하였다. A cost-effectiveness threshold is required when deciding whether a new healthcare technology is too expensive. There are generally two perspectives on what a cost-effectiveness threshold should reflect. A demand-side approach emphasizes the consumption value of health, whereas a supply-side approach emphasizes the opportunity costs of funding decisions. In recent years, there has been growing attention on the opportunity cost-based threshold, especially with the rise of high-cost healthcare technologies. This study, therefore, conducted a systematic review of studies estimating the opportunity cost-based thresholds. A total of 17 studies were included in this review, of which 14 conducted country-specific analyses. These studies generally estimated the marginal cost per unit of health produced within the health care system. Threshold estimates were relatively lower in the UK, Australia, and other upper-middle-income countries such as China and Colombia than in the United States and Nordic countries, which were well below the GDP per capita. In addition, methodological approaches taken in the included studies were thoroughly reviewed and analyzed to derive methodological implications and insights. These findings, together with the local context and the type of data available, should be fully taken into account when estimating one such threshold in Korea.
권상일(Sangil Kwon),이우석(Wooseok Lee),홍지형(Jihyung Hong),김현근(Hyungeun Kim),명차리(Cha-Lee Myung) 한국자동차공학회 2009 한국자동차공학회 학술대회 및 전시회 Vol.2009 No.11
UN-GRPE Particulate Measurement Programme (PMP) is a collaborative programme operating under the auspices of the UNECE/GRPE Group. Its focus is on the development of a new approach to the measurement of particle in vehicle exhaust emissions, which may be used to replace or to complement the existing mass based system used for regulatory purposes. This paper is the test results of PMP Heavy-Duty Round-Robin during May to June '09 conducted at National Institute of Environmental Research (NIER) in Korea to analyze the repeatability and reproducibility between laboratories. In addition to regulated gaseous emissions, the real time particle emission was simultaneously measured with CPC, and EEPS during the daily protocol described in "UN-GRPE PMP Phase 3: Inter-laboratory Correlation Exercise: Updated Framework and Laboratory Guide for Heavy Duty (HD) Engine Testing" Detailed particle emissions over various engine certification cycles showed that the particle number concentration (#//kWh) was 3.508E+11 (weighted WHTC), 6.087E+10 (WHSC), 4.596E+10 (ETC), and 3.389E+12 (ESC) respectively. Particle mass (g/kWh) was ranged from 0.0011 (WHSC) to 0.0031 (ESC). The repeatability of particle number and mass were reached about 22~107% and 25~73%. The large CoV of particle emissions was ascribed by ETC mode which value 107% and 73%.
경제성평가자료제출생략 트랙으로 진입한 약제에 대한 외국의 치료적 이익 평가 결과 비교
배은영(Eun-Young Bae),차소희(Sohee Cha),임화령(Hwa-Ryeong Lim),이혜재(Hye-Jae Lee),홍지형(Jihyung Hong) 대한약학회 2024 약학회지 Vol.68 No.1
This study assessed the additional health benefits of the drugs listed through the Economic Evaluation Exemption Procedure (EEEP) in Korea. We conducted a comparative review of 32 EEEP drugs listed between May 2015 and July 2022, comparing how they were assessed in France, Germany, and Canada. To collect the data, we reviewed the evaluations conducted by the relevant agency in each country and identified if the additional benefit exists and how significant it is. Additionally, the size of the benefit gains assessed by each agency was categorized as “High” or “Low,” allowing us to evaluate the consistency among these countries. In France, only 38% of the 34 drugs compared demonstrated moderate or higher levels of additional benefit. Germany acknowledged substantial benefit improvement in 27% of the 30 drugs assessed, while 73% showed minor, unquantifiable, or no additional benefits. In Canada, 5 out of 22 cases have been identified as providing significant additional benefit. The level of inter-country consistency in the assessment results from these three countries was somewhat limited. Based on the evaluation results in France, Germany, and Canada, the additional benefits of EEEP drugs over existing treatments were not substantial in many cases. Even though the EEEP was introduced to improve accessibility to high-cost drugs for medical conditions with unmet needs, it is necessary to reconsider whether to allow exceptions for drugs with low therapeutic value.