Breast cancer screening has proved to be efficacious only in clinical trials or structured programs. However, little is known of its effectiveness as a regular practice. This study is an assessment of breast cancer screening in regular practice in a Spanish area of 350,000 inhabitants through analysis of existing sources of information. It is evident that this screening is insufficient, inefficient, very variable, nonspecific, and probably ineffective, although there is insufficient information to prove it. The immediate implementation of a well structured and accredited screening program is essential to overcome the current limitations.

This article highlights factors that may cause bias in individual controlled trials or meta-analysis of zidovudine (AZT) in HIV disease. The overall benefit of AZT and antiretroviral drug combinations in the progression of HIV disease is probably greater than has been or can ever be shown in an ethical controlled trial.

There is a paucity of research regarding the contribution of “low-cost” technologies to the escalation of medical costs in the United States. We examined total charges for medical and surgical supplies (MSS) among all hospitalized Medicare beneficiaries in 1994; a total of US $16.8 billion was spent on MSS, or $1,397 per hospitalization. For selected surgical procedures, both the proportion of total hospital charges attributed to MSS and the mean charge per hospitalization were considerably higher. Concerns regarding excessive payments for MSS and the lack of accountability by the Medicare program are discussed. Itemization of MSS supplies may serve to eliminate wasteful use and lead to decreased costs.

We analyze Argentina's demographic and socioeconomic data as the context for understanding its health sector. Health expenditures and the number of physicians are high in Argentina. Health coverage is extensive, but covers only about 50% of the per capita expenditures. The high expenditures in health do not correlate with improvements of indicators such as infant and general mortality. Evaluations of the way health care is provided are insufficient. Argentina's “medical-intensive” model of health is responsible for the expansion of the “small-ticket technology”, which accounts for a significant proportion of the increase in health expenditures. With this picture, we believe that health decision-makers could benefit from cost-effectiveness analysis (CEA), because this technique stresses the relationship between expenditures and appropriately defined goals. As a demonstration project, we look at the way that technology is used in Argentina using CEA to assess anesthesia procedures. The results of our study show that increasing the use of N2O would save us $670,000 per year, and 10,300 years of life to surgical patients of all ages.

Ceará occupies an area of 146,817 km2 in northeastern Brazil, where the climate is tropical and there are only two seasons, rainy and dry. Frequent droughts have serious consequences for subsistence farming, resulting in precarious living conditions for the rural inhabitants. In the absence of any industry to provide employment for labor, low incomes prevail, with 90% of the population receiving incomes below the minimum wage for farm workers (9).

Magnetic resonance imaging (MRI) is a rapidly evolving medical technology which has become widely diffused before comprehensive assessment of its safety, efficacy, cost-effectiveness, and relative cost-effectiveness compared with diagnostic modalities that it seems most likely to replace could be made. In early 1982 there were fewer than ten units worldwide. In August 1984, there were about 150 units and the figure will be closer to 300 by the end of 1985.

The time invested by patients and informal caregivers in treatment and rehabilitation should be valued in a cost-effectiveness analysis (CEA). The Washington Panel gives recommendations on incorporation of time costs that may misrepresent true societal costs. This article provides alternative recommendations for incorporating costs of time in CEA. Following an opportunity costs approach, time is separated into three parts, each with its own valuation methods: time spent on paid work, unpaid work, and leisure.

The treatment of End-Stage Renal Disease (ESRD) is one of the most widely debated topics in contemporary medicine. The high cost of the most usual treatment, hemodialysis, has been and still is the topic for numerous discussions concerning priorities in health care on the one hand, and various medical, psychological, and ethical problems of life “on the machine” on the other hand. The other treatment of ESRD, kidney transplantation, raises other, no less complicated questions such as the limits of medical experimentation, ownership of one's body, the donation of organs, organ procurement and allocation, and the definition of life and death. As Fox and Swazey put it “The importance of hemodialysis and human organ transplantation lies as much in their social and cultural significance as in their medical and surgical value” (27,376).

The availability and efficacy of recombinant deoxyribonucleic acid yeast-derived hepatitis-B vaccine, at a price much lower than the previously available plasma-derived hepatitis-B vaccines against hepatitis-B virus infections, motivate a new cost-benefit analysis of hepatitis-B vaccination. Spanish data were used to calculate direct and indirect costs of hepatitis-B infection and the costs and benefits of different vaccination strategies in defined risk groups of the Spanish population. A vaccination program will reduce direct expenditures for hepatitis B if the attack rate in the target population is higher than 4.9%. If indirect costs are included, the threshold for cost saving is reduced to 0.9%. The results are sensitive to the price of the vaccine, the duration of protection, assumptions about consequences for quality of life, and to indirect costs.

The North Slope Borough (NSB) Telehealth Project involves the use of slowscan (freeze-frame video) and telephone communications between 7 small villages, a central 14-bed hospital, and a large urban hospital over 700 air miles away. The project is intended to improve the quality of health care in this remote rural area in northernmost Alaska. This article describes the initial testing stages of the project and discusses applications for use of this technology. It focuses on the technological potentials for bridging cultural and linguistic differences between health care provider and client and from provider to provider for enhanced primary health care.

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.”

In less than four years, the techniques of gene transfer have been taken from the laboratory and translated into numerous clinical trials. Although gene therapy was initially designed for the molecular repair of monogenic deficiency diseases, most of the current studies of gene therapy are targeting cancer.