의료기술평가를 이용한 근거중심 의사결정제도
Health Economics, Health Technology Assessment, and Cost Effectiveness Analysis
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우리나라는 아시아 국가들 중 최초로 2007년 신약등재에 경제성평가를 통한 선별등재제도와 신의료기술평가를 통한 근거중심의 유효성과 안전성평가를 도입함으로써 의료기술평가를 선진적으로 제도화시켰다는 평가를 받고 있다. 이 종설에서는 의료기술평가와 관련된 여러 개념들을 명확히 정리하고 특히 의료기술평가를 통한 근거중심 의사결정제도를 위한 방향설정을 위하여 국내외의 차이점을 중심으로 정리해 보았다. 국외의 제도가 반드시 옳다고 볼 수는 없으나 보건의료 의사결정의 정당성을 위하여 갖추어야 할 조건으로 널리 인용되는 Daniels(2008)의 해명책임(accountability for reasonableness)의 개념들이 우리나라 제도에서도 반영되는 것이 미래지향적인 방향으로 생각된다. 의료기술평가는 의료기술의 유효성, 안전성, 비용효과성에 관한 다학제적인 종합적 평가연구로 의사결정 자체가 아니라 합리적인 의사결정에 도움을 줄 수 있는 근거제공을 의미한다. 과학적인 연구를 통한 Assessment와 이를 비판적으로 평가하여 의사결정에 이용하는 appraisal은 구분될 수 있고 각 과정에서 투명성 등 해명책임의 증대를 통하여 보다 합리적인 의사결정에 도달할 수 있다.
Abstract
Korea is the first country to legislate health technology assessment system by introducing positive listing for new pharmaceuticals and new health technology assessment for new procedures and diagnostics since 2007. This review tried to clearly define the concepts related to the health technology assessment. Especially, for setting a direction of evidence based decision making system using health technology assessment in Korea, the differences between domestic system and overseas system were compared. Though the overseas system may not be always correct but improving accountability in the current Korean system seems to be a future direction considering the accountability for reasonableness (A4R) argument by Daniels (2008). Health technology assessment is a multidisciplinary synthetic evaluation research on clinical effectiveness, safety, and cost-effectiveness of the health technology. It is not a decision making itself but a provision of helpful evidences to a rational decision making. Assessment process of scientific research and critical appraisal of the results to use in decision making process can be distinguished. Increasing transparency in these processes can improve accountability for reasonableness in Korea and hence, warrants a rational decision making.
참고문헌 (24)
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