[Assessment of medical measures]. / Zur Bewertung medizinischer Massnahmen.

PURPOSE: Recently, the discipline Health Economics gained considerable interest. This interest was stimulated by the experienced limitations of resources and cost containment which requires the analysis of the values of treatments based on their relative costs and outcomes. The experiences of limited resources could lead to purely cost-based decisions such as favoring inexpensive services instead of facilitating the access to better and more useful ones. In order to decrease the risk of such uneconomic decisions we propose a hierarchy of assessments for the evaluation of clinical services. RESULTS: This hierarchy is based on the distinction of effectiveness and utility of medical service. Effectiveness is expressed in variable dimensions such as duration of sleep, concentration of blood sugar or diameter of a lesion. Utility is expressed by prolongation of survival and/or improvement of quality of life. The hierarchy suggests to assess the clinical utility from the patient's point of view as a first step by measuring the effects of the service on quantity and quality of life. In a second step, the clinical value of alternative medical interventions from the patient's point of view should be assessed by measuring the patient preference prospectively or the patient compliance retrospectively. Finally, as a third step, the economic value is assessed by comparing costs with outcomes. CONCLUSIONS: The suggested hierarchy should support the selection of the most useful services among alternative measures. In addition it should stimulate cooperation between the involved disciplines.

Symposium on health economics in oncology. Freiburg, Germany, June 1995.

Dr. E. Enghofer (Wien, Austria) summarized the content of the presentations and discussions of the symposium in his concluding remarks. 1. The organizers should be congradulated on their initiative in bringing together at the symposium experts from different disciplines, i.e., medicine, ethics, health economics, jurisprudence, the pharmaceutical industry and, last but not least, cost providers. 2. Health economics as an issue in health care has been around for quite some while. One example can be found in the German Drug Guidelines dating back to 1990, where the following terms have already been defined: therapeutic benefit, medical needs, and achieving therapeutic goals. 3. Health economics serves as a "support function" in the medical decision-making process. It has as yet no decisive role in the application to license a drug nor in questions concerning a physician's liability. Health economics as a discipline, however, was a reminder of, and served as a catalytic function for: a) The differentiation between the benefit of a medical intervention and its pure effectiveness. b) The definition of medical standards as a means to compare the quality of health care between different institutions, to uncover quality deficits and to develop strategies for the optimization of medical quality (quality management). Routine deviation from these standards is unethical. The German Cancer Society has taken on the task of defining such standards in cancer care. c) The difference between rationalising and rationing health care. The spending of the current health-care budget needs to be screened for unnecessary and/or inappropriate diagnostic procedures and treatment modalities as well as for "below-standard" care. The money that can be saved here can then be shifted towards financing "state of the art" medicine or can be used in the decision to substitute certain procedures. 4. The a priori definition of the desired outcome of a medical intervention is of paramount importance for the evaluation of the actual treatment result. Economical evaluations are easier when cure rather than palliation is the aim of a particular treatment and when alternative therapies do exist such that cost comparisons are possible. In any case, therapeutic interventions need to be adapted to the desired treatment goal; only then can the question be answered whether or not the means (cost) are (is) justified. 5. Outcome studies need to take into account every relevant medical aspect (i.e. disease management studies), and they should be accompanied by evaluation studies. The latter must also include unselected patients in daily practice.(ABSTRACT TRUNCATED AT 400 WORDS)