To explore the contribution of health care to the excellent health status enjoyed by the Japanese compared with other industrialized populations, the preoperative health status of a retrospective cohort of 256 patients who underwent total hip replacement in Japan was compared with 301 patients in England (and published data from the United States). Patients in Japan had less severe hip disease, less comorbidity (in particular, less cardiovascular disease), and were in better general health. This finding suggests that health care contributes little to explaining the better health of people in Japan compared with England and the United States.

Some studies suggest that breast-conserving treatment increases the cost of breast cancer. Estimates from a social perspective show that incremental cost depends on the proportion of lumpectomies done in outpatient facilities and on the demand for reconstructive surgery. Conservative treatment reduces spending within a reasonable range of values.

Objective: To determine the incremental cost-effectiveness of magnetic resonance imaging (MRI) and computed tomography (CT) in young adults presenting with equivocal neurological signs and symptoms. Designs and methods: A decision analysis of long-term survival using accuracy data from a diagnostic technology assessment of MRI and CT in patients with suspected multiple sclerosis, information from the medical literature, and clinical assumptions. Main results: In the baseline analysis, at 30% likelihood of an underlying neurologic disease, MRI use has an incremental cost of $101,670 for each additional quality-adjusted life-year saved compared with $20,290 for CT use. As the probability of disease increases, further MRI use becomes a cost-effective alternative costing $30,000 for each quality-adjusted life-year saved. If a negative MRI result provides reassurance, the incremental costs of immediate MRI use decreases and falls below $25,000 for each quality-adjusted life-year saved no matter the likelihood of disease. Conclusions: For most individuals with neurological symptoms or signs, CT imaging is cost-effective while MR imaging is not. The cost-effectiveness of MRI use, however, improves as the likelihood of an underlying neurological disease increases. For selected patients who highly value diagnostic information, MRI is a reasonable and cost-effective use of medical resources when even the likelihood of disease is quite low (5%).

Preference assessment literature has debated the equivalence of the healthy years equivalents (HYE) and time trade-off (TTO) methods. The central issue is whether the HYE measures preferences under uncertainty. This work shows that the two stages of the HYE first add and then remove the element of uncertainty so that ultimately the technique does not measure preferences under uncertainty. This makes the HYE, at best, a cumbersome equivalent of the TTO.

Data relevant to economic evaluation are being collected alongside clinical trials with increasing frequency. When these trials involve health outcomes and resource utilization in many different countries, numerous methodologic problems arise. This paper describes and discusses the methodology for economic evaluation that will be used in the Economic Substudy of GUSTO llb, as an example of how to address the problems that arise in economic evaluations linked to international trials.

We aimed to establish a 1996 baseline of new health care technologies that are predicted to have an impact on the United Kingdom's National Health Service in the next five years. One thousand and ninty-nine health care technologies were identified from a variety of sources. Further work will attempt to determine the most efficient method of identifying and monitoring new health care technologies.

Methodology for evaluation of impact of health technology assessments (HTAs) is outlined and its use illustrated by applying it to 21 HTAs produced by CETS. Impact on policies and technology diffusion was identified in documents, through interviews, questionnaires, and use of data banks. There was evidence that all but three reports influenced policy and that cost-minimization studies caused savings of between $16 million and $27 million annually. Precise estimates of impact will seldom be possible, but systematic documentation of effects is feasible.

Health technology assessment (HTA) has increasingly become a valuable tool to examine effectiveness, quality of care, patient outcomes, and cost-effectiveness of health care technologies. In 1994 and 1995, a survey was conducted to document the scope of worldwide HTA activities; 103 organizations from 24 countries responded. This paper summarizes the results of this international survey, including a description of each country's program, types of technologies assessed, methodologies used, and dissemination approaches. Results for Canada, the United States, and European and other countries are presented separately.

Analysis of the 1987–1991 national outpatient claims data shows that the percentage of patients undergoing sophisticated diagnostic tests tended to increase and was greater if the hospital was larger, in the public sector, or affiliated with an university. For imaging, the percentage that had CAT scans performed increased, while the percentage undergoing x-rays using contrast medium and other tomography decreased. However, for drugs, newer and more expensive ones tended to be preferred irrespective of the providers' characteristics. Although costs arising from the shift to more expensive and sophisticated technologies have been largely contained by reducing their prices in the fee schedule, this cost-containment strategy faces structural problems. We advocate the establishment of an infrastructure that offers incentives for providers to conduct technology assessment and to use the results.

Research in unconventional medicine requires a number of different questions to build up a “mosaic” of evidence. Choice of research design depends on the question being asked and is independent of the therapy under investigation. Despite the doubts of some practitioners, randomized trials are of value for determining certain questions in alternative medicine.