【摘要】 药物经济学以福利经济学为基础，作为典型的规范经济学，使用成本-效果阈值作为经济学的价值判断标准。中国指南推荐的1～3倍人均国内生产总值（GDP）虽然可以作为一个参考标准，但医保决策的实际阈值并未公开披露。意愿支付（WTP）作为常用阈值来源之一，多用于成本-效果平面第一象限的决策；而在第三象限则应使用意愿接受（WTA），其约为WTP的两倍。两者的差异主要源于个人偏好、替代品的存在以及禀赋效应，这些因素导致成本-效果平面上阈值的“扭曲”，形成从原点向第三象限弯折的“拐弯”阈值。这不仅引起第三象限阈值的增大，也对成本-效果可接受曲线下药品的经济学概率造成影响。尽管位于第三象限的药品效果稍差、成本更低，但在资源有限的情况下，通过优化资源配置可以改善总体健康结果，值得决策者的关注。更多还原

【Abstract】 Pharmacoeconomics, based on welfare economics, is a typical form of normative economics and uses cost-effectiveness thresholds as the standard for economic value judgment. In China, the commonly recommended threshold of 1 to 3 times gross domestic product(GDP) per capita serves as a reference, but the actual thresholds used in reimbursement decisions are not publicly disclosed. Willingness-to-pay(WTP), a widely used threshold source, is often applied in decision-making within the first quadrant of the cost-effectiveness plane. In contrast, decisions in the third quadrant should theoretically use willingness-to-accept(WTA), which is approximately twice the value of WTP. The discrepancy between WTP and WTA arises mainly from individual preferences, the availability of substitutes, and the endowment effect. This leads to a "distortion" of the threshold on the cost-effectiveness plane, forming a "bent" threshold curving toward the third quadrant. This not only raises the threshold in the third quadrant but also influences the probability of economic acceptability for a drug under the cost-effectiveness acceptability curve. Although drugs in the third quadrant may be slightly less effective but lower in cost, they can improve overall health outcomes through better resource allocation in resource-limited settings and therefore deserve policymakers’ attention.更多还原