E. Role of Budget Impact Analysis 预算影响分析的作用

Budget-impact analysis determines the impact of implementing or adopting a particular technology or program on a designated budget. 预算影响分析确定了在指定预算中实施或采用特定技术或计划的影响。The designated budget is generally the responsibility of a particular health care program or authority, e.g., a drug plan or formulary, a hospital, an employer-sponsored health plan, or a regional or national health authority (Mauskopf 2007). It does not necessarily account for the broader economic impact (e.g., societal impact) of implementing or adopting the technology. 这不一定说明实施或采用该技术的更广泛的经济影响（如社会影响）。BIAs can take different forms. BIA 可以采用不同的形式。For example, a BIA can be conducted simply to determine how much a technology would increase or decrease a particular budget. 例如，可以简单地进行BIA来确定技术将增加或减少特定预算的数目。Or, it could be conducted to determine whether, or to what extent, one or more technologies could be implemented within a fixed (or “capped”) budget. 或者，可以决定在有限（或“限制”）预算内能否实施或在多大程度上实施一种或多种技术。BIAs have appeared with increasing frequency during the past decade, along with greater attention to improvement and standardization of their methods, transparency, and reporting, including with respect to the uses of BIA given decision makers’ various economic perspectives (Orlewska 2009).

A BIA might incorporate a CEA to determine the most cost-effective combination of technologies that can be implemented subject to a budget constraint. BIA可能会结合CEA，以确定可在有限预算情况下，最具性价比的技术组合。However, a CEA is not a substitute for a BIA; indeed, a CEA may yield an inappropriate finding for making budgetary decisions. 然而，CEA不能替代BIA；事实上，CEA可能会产生一个对做预算决策而言不恰当的结果。例如，非主流人群筛查的CEA可能表明技术A是最具性价比（例如，以检测到每例癌症的花费）。However, allocating resources efficiently (e.g., maximizing cost-effectiveness) may not be consistent with affordability, i.e., remaining within a fixed budget. 然而，有效地分配资源（例如，最大化成本效果）可能与支付能力并不一致，即在有限预算内。As such, a fixed budget amount may be too small to implement technology A for the full designated population, forcing the use of an alternative (less cost-effective) technology, no technology, or a policy to limit the use of technology A to fewer people in order to remain within the fixed budget. 因此，固定预算金额可能因为太小，而无法为所有的特定人口实施技术A，从而不得不使用替代（较低成本效果）技术、无技术或为了维持固定预算，政策将限制使用技术A。Box V-11 presents a hypothetical example of a BIA in which a budget constraint is contrary to selecting the most cost-effective alternative. The need for a health program (such as a drug formulary) to operate within a particular budget constraint may be contrary to selecting a technology that is cost-effective or even cost-saving for the broader health care system. 在特定的预算约束下，一个健康计划（如药物处方集）的所需的技术可能与更广泛的医疗系统选择的高性价比甚至节省成本的技术相反。This is a form of the “silo budgeting” problem, in that each budget is managed independently of other budgets and of the overall health system. 这是“筒仓预算”问题的一种形式，因为每个预算都是独立于其他预算和整个卫生系统进行管理的。The inability to transfer funds across these silos can undermine system-wide efficiency. 无法将资金转入这些孤岛可能会渐渐降低整个系统的效率。

Box V-11. Cost Effectiveness of New Intervention ‘A’ in the Context of a Fixed Budget: A Hypothetical Budget Impact Analysis 在固定预算内，新干预“A”的成本效果：假设预算影响分析

How should a fixed annual budget of £500,000 be allocated?It would be most cost-effective to provide Intervention ‘A’ to patients age >75 years. However, there is insufficient budget to provide the intervention to all patients in that subgroup. 然而，没有足够的预算来为该分组中的所有患者提供干预。Although there is sufficient budget to provide the intervention to all patients age 45-60 years, this is not the most cost-effective approach. 虽然有足够的预算为所有45-60岁的患者提供干预，但这并不是最具成本效果的方法。

Source: With kind permission from Springer Science+Business Media: Pharmacoeconomics, Developing guidance for budget impact analysis, 19(6), 2001, 609-21, Trueman P, Drummond M, Hutton J, Figure 1, and any original (first) copyright notice displayed with material.