Valuing Clinical Strategies Early in Their Development
Authors: H. Gilbert Welch
Journal: Annals of Internal Medicine (1992)

Editorials1 February 1992Valuing Clinical Strategies Early in Their DevelopmentH. Gilbert Welch, MD, MPHH. Gilbert Welch, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-116-3-263 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe unremitting growth of health expenditures has created growing demands on physicians to justify diagnostic and therapeutic strategies. To do so, physicians usually focus on the question of whether treatmentscanwork in the ideal—the question of efficacy (1). Because efficacy is assessed in highly controlled environments, physicians have focused more recently on whether treatmentsdowork under the conditions in which they are applied in practice—the question of effectiveness (2). However, because neither efficacy nor effectiveness measures the resources required to achieve an outcome, physicians have also become interested in the question ofcostrequired to achieve a given...References1. FletcherFletcherWegener RSE. Clinical Epidemiology—The Essentials. Baltimore: Williams & Wilkins; 1982:146. Google Scholar2. RoperWinkenwerderHackbarthKrakauer WWGH. Effectiveness in health care. An initiative to evaluate and improve medical practice. N Engl J Med. 1988;319:1197-202. CrossrefMedlineGoogle Scholar3. Cochrane A. Effectiveness and Efficiency: Random Reflections on Health Services. Cambridge, England: The Nuffield Provincial Hospitals Trust and the Cambridge University Press. 1972. Google Scholar4. GulatiBennett SC. Granulocyte-macrophage colony-stimulating factor (GM-CSF) as adjunct therapy in relapsed Hodgkin's disease. Ann Intern Med. 1992;116:177-82. LinkGoogle Scholar5. KukullKoepsellConradImmanuelProdzinskiFranz WTDVJC. Rapid estimation of hospitalization charges from a brief medical record review. Med Care. 1986;24:961-6. CrossrefMedlineGoogle Scholar6. AdvaniChaoHorning RNS. Granulocyte-macrophage colony-stimulating factor (GM-CSF) as an adjunct to autologous hemopoietic stem cell transplantation for lymphoma. Ann Intern Med. 1992;116:183-9. LinkGoogle Scholar7. PowlesSmithMilanTreleavenMillarMcElwain RCSJJE. Human recombinant GM-CSF in allogeneic bone-marrow transplantation for leukaemia: double-blind, placebo-controlled trial. Lancet. 1990;336:1417-20. CrossrefMedlineGoogle Scholar8. NemunaitisRabinoweSingerBiermanVoseFreedman JSJPJA. Recombinant granulocyte-macrophage colony-stimulating factor after autologous bone marrow transplantation for lymphoid cancer. N Engl J Med. 1991;324:1773-8. CrossrefMedlineGoogle Scholar9. KharazmiNielsenHovgaardBorregaardNissen AHDNN. Modulation of neutrophil and monocyte function by recombinant human granulocyte macrophage colony-stimulating factor in patients with lymphoma. Eur J Clin Invest. 1991:21:219-24. CrossrefMedlineGoogle Scholar10. LuftBunkerEnthoven HJA. Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med. 1979;301:1364-9. CrossrefMedlineGoogle Scholar11. GreenspanKayBergerGreenbergGreensponGaughan AHBRAM. Incidence of unwarranted implantation of permanent cardiac pacemakers in a large medical population. N Engl J Med. 1988;318:158-63. CrossrefMedlineGoogle Scholar12. WinslowSolomonChassinKosecoffMerrickBrook CDMJNR. The appropriateness of carotid endarterectomy. N Engl J Med. 1988;318:721-7. CrossrefMedlineGoogle Scholar13. SackettHaynesGibsonHackettTaylorRoberts DREBDR. Randomized clinical trial of strategies for improving medication compliance in primary hypertension. Lancet. 1975;1:1205-7. CrossrefMedlineGoogle Scholar14. FisherMalenkaWennbergRoos EDJN. Technology assessment using insurance claims. Example of prostatectomy. Int J Technol Assess Health Care. 1990;6:194-202. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Department of Veterans Affairs Hospital Dartmouth-Hitchcock Medical Center White River Junction, VT 05009 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByWorldwide Network for Blood and Marrow Transplantation (WBMT) recommendations for establishing a hematopoietic stem cell transplantation program in countries with limited resources (Part II): Clinical, technical and socio-economic considerationsWorldwide Network for Blood and Marrow Transplantation Recommendations for Establishing a Hematopoietic Stem Cell Transplantation Program in Countries with Limited Resources, Part II: Clinical, Technical, and Socioeconomic ConsiderationsEstablishing an HSCT Program with Limited ResourcesDoes Reimbursement Affect Physician Decision Making?The Impact of Climcal Guidelines On Practice Patterns: Doing More versus Doing LessEconomic Analyses in Clinical Trials for Cooperative Groups: Operational ConsiderationsCost-effective models for flutamide for prostate carcinoma patients: Are they helpful to policy makers?Advances and issues in the pharmacotherapy of rheumatoid arthritisRecombinant growth factorsThrombolytic Therapy for Acute Myocardial Infarction: GUSTO CriticizedWhy should gastroenterologists know about outcomes research? 1 February 1992Volume 116, Issue 3Page: 263-264KeywordsRivers Issue Published: 1 February 1992 PDF DownloadLoading ...