In most of the cost-utility literature, quality-adjusted life-year (QALY) gains are interpreted as a measure of social value. Given this interpretation, the validity of different multi-attribute health-state scaling instruments may be tested by comparing the values they provide on the 0–1 QALY scale with directly elicited preferences for person trade-offs between different treatments (equivalence of numbers of different patients treated). Norwegian and Australian public preferences as measured by the person trade-off suggest that the EuroQol Instrument assigns excessively low values to health states. This seems to be even more true of the McMaster Health Classification System. The Quality of Well-being Scale appears to compress states toward the middle of the 0–1 scale. By contrast, the Rosser/Kind index fits reasonably well with directly measured person trade-off data.

Non-A non-B hepatitis is the most common serious sequela of blood transfusion, and its screening has become an essential goal of blood transfusion centers. Before 1989, two surrogate screening tests (for alanine aminotransferase and for antibody to hepatitis B core antigen) were used; in 1989, a direct test for the antibody to hepatitis C virus (the main agent of this hepatitis) was developed. The French National Agency for the Development of Medical Evaluation undertook an investigation to determine the optimal prevention strategy for posttransfusion non-A and non-B hepatitis (PTH). A detailed literature review was performed, complemented by expert group opinion. The performance of each test was derived indirectly by calculating the number of cases of PTH averted by each test. Hepatitis C virus testing is probably the most promising strategy, but different policies can be developed given the uncertainties of scientific data. Cost considerations should be taken into account in identifying the best screening strategy.

Recombinant human erythropoietin is an efficacious therapy in treatment of the anemia of end-stage renal failure. However, the scale of impact on quality of life and medical care resources remains uncertain. By reviewing the literature we evaluate cost-effectiveness of recombinant human erythropoietin and show how previous studies may have implicitly overestimated cost-effectiveness.

Little is known about the consumption of medical and surgical services by the most informed consumer in the health care market: the physician-patient. Such knowledge should be important for the understanding of the role of information on consumption, supplier-induced demand, the doctor-patient relationship, unnecessary medical services, and the adequacy of professional practices to the real health needs of the “ordinary patient.” We measured by questionnaire the standardized consumption of seven common surgical procedures. Except for appendectomy, the age- and sex-standardized consumption for each of the common surgical procedures was always significantly higher in the general population than for the “gold standard” of physician-patients. The data suggest that (a) contrary to prior research, doctors have much lower rates of surgery than does the general population; and (b) in a fee-for-services health care market without financial barriers to medical care, less-informed patients are greater consumers of common surgical procedures.

Hospital reviews based on an adaptation of Gertman and Restuccia's Appropriateness Evaluation Protocol were performed by acute care hospitals and the canton of Vaud (Switzerland) public health department in three settings during a six-month period in 1990–1991. Interrater agreement between hospital and public health department reviewers was measured on 1,847 days of consecutively admitted patients during the last weeks of the reviews.

A major assessment of magnetic resonance imaging (MRI) in Australia influenced the early use of this technology and informed policy decisions on future MRI services. However, the impact of the assessment, and of government policy, on the subsequent diffusion of MRI has been more modest, reflecting the limitations of the evaluation process in a complex health care system.

This study describes decision making regarding the acquisition of technology in 12 major medical centers. The financial impact of a project was the most widely cited criterion of decision, but financial considerations were less important than either the impact of a technology on the quality of clinical care or its contribution to teaching and research. Rarely were criteria set out explicitly or in advance. Although exemplary models exist, the technology assessment process at most institutions is described as “political,” “informal,” or “ad hoc.”

Age-specific (<50, 50–69 years) 10-year survival proportions in four European trials for node-negative, Stage I and II breast cancer patients differ significantly. These patients, identified as having the same stage as localized-breast cancer patients in the End Results Registry of the U.S. National Cancer Institute, had pooled survival proportions for the two age groups (0.713, 0.579) close to those of the registry (0.713, 0.607).

Collaboration within the European Community (EC) over health problems and their possible solutions has progressed significantly during the past decade. The pursuit of appropriate choices among a variety of issues has resulted in a growing demand for comparable health data. EC efforts to coordinate the health services research of the member states in the fourth Medical and Health Research Program (1987–1991) are discussed. Its contribution to the development of information relevant to the EC's health needs as well as financing, policies, and practices is outlined.

The Quebec Council on Health Care Technology Assessment was created in 1988. Its functions are to promote, support, and produce health care technology assessments and to advise the Minister of Health. An independent review of the council’s first four years of operation was commissioned. The evaluation team concluded that the council showed very good results in terms of the scope, quality, and impact of its production and succeeded in establishing its credibility. However, the evaluation team suggested that the council adopt a more active strategy toward the promotion and diffusion of its reports. Some critical determinants of success of the Quebec experience in technology assessment are discussed.

Ten picture cards, interviews, time logs, and the Klein-Bell ADL scale were useful in assessing the benefits of electrically adjustable beds to patients but not to caregivers. The mean cost per bed per year of US $346 seems, in relation to the benefits, to be a worthwhile investment for increasing patients' quality of life.

Once-daily antibiotics (ODAs) represent a technological change in hospital processes that can lead to substantial savings of scarce resources. In a three-hospital prospective study, five antibiotics were administered to 58 patients suffering from infections classified by major body system. Savings ranged from 10.9% to 38%, depending on hospital organization, method of delivery, and daily dose. Per-unit price proved a poor indicator of hospital cost, as variable delivery costs for labor and materials ranged from 11.6% to 39.5% of total costs.