Objectives: The purpose of this study was to determine and inform clinicians, managers, and budget allocators of the costs incurred to the British National Health Service (NHS), patient, and society when attending clinic-based physiotherapy compared with not attending clinic-based physiotherapy after arthroscopic partial meniscectomy surgery.

Methods: The valuation principle used in this study was the economic concept of opportunity cost. Costs were referred to as direct medical (NHS), direct nonmedical (patient), and indirect (societal) costs. Due to the difficulties of their measurement and valuation, intangible costs, in the form of pain and anxiety related to the effect of receiving or not receiving treatment, have not been considered in this analysis.

Results: Providing clinic-based physiotherapy after knee arthroscopic partial meniscectomy surgery is more costly to the NHS and patient, but no more costly to society than when not providing it and does not result in reduced contact with the NHS.

Conclusions: Clinic-based physiotherapy after knee arthroscopic partial meniscectomy surgery is costly and evidence is needed that its effectiveness is high enough to support its use.

The authors present their experiences in assisting the government of Niger to develop automated information systems for health care management. They discuss the structure of the health system, the role of donor assistance, the process of initiating automated systems, and the technical requirements and costs of the system. Finally, they draw general conclusions that may be useful for those attempting similar efforts.

Economic evaluations can be used to compare alternative antenatal care programs in terms of cost and outcome. The cost of routine antenatal care is small compared to the total cost associated with pregnancy and childbirth. The main problem in economic evaluations is related to outcome measurement.

In 1979, maternal and child health issues were discussed during the annual meeting of the 33 Member States of the European Region of the World Health Organization. During this discussion many countries expressed concern about the services offered for pregnancy, birth and the period following birth. The countries recognized that, as yet, unsolved problems remain which must be examined and they asked the European Regional Office of WHO to mount activities to study and report on these problems surrounding birth and birth care. In response to this request, the maternal and child health unit of the European Regional Office organized a Perinatal Study Group. The Group's 15 members came from 10 countries and spanned 10 professional disciplines: economics, epidemiology, health administration, midwifery, nursing, obstetrics, pediatrics, psychology, sociology, and statistics. For five years the Group conducted surveys, reviewed the literature and brought its own personal and professional experience to discussions of the health services for women and their babies, during pregnancy and birth, and after birth. The entire group met together at least once a year, at which time findings from the previous year's work were presented, followed by lengthy, sometimes heated, open and free discussions.

Sweden's first, and so far only, ESWL unit for kidney stone treatment became operational on April 1, 1985. This paper presents some intermediate results from an integrated medical, economic, and technical evaluation of the new technology. Seventy-eight percent of 477 patients were defined as successfully treated, totally stone free or fragments less than 4 mm in size, after a follow-up of four weeks. After six months, the share of successfully treated patients had increased to 82%. Successes were closely related to the stone situation; the smaller the stone, the greater success of treatment. Patients' experiences with treatment were also studied and showed that less than 5% of the patients perceived the treatment as unpleasant, frightening, and/or time consuming. Epidemiological data reveal that one unit can replace all open surgical operations on the kidney.

During 1984–1985, laminectomy rates in Massachusetts demonstrated a 2.2-fold variation among districts. Thirty-five percent of laminectomies occurred in 7 of the 108 hospitals studied. Approximately 81% of laminectomies were performed by neurosurgeons. Rates of laminectomy decline with increasing age after 65, while rates of hospitalization for lower-back pain rise.

High technology developments in diagnostic imaging raise a number of issues that are disturbing. New developments do not always favor greater diagnostic efficacy since fads, marketing promotion, and entrepreneurs can distort medical goals. New advances disseminate rapidly in affluent societies before formal benefit evaluations are completed. We suggest that digitization of radiography must be critically assessed, and simplicity of equipment design should be promoted. Though medical and economic factors can provide guidelines for policy making, the ultimate priority decisions are political in nature.

The growing global focus on and sense of urgency toward improving healthcare environmental sustainability and moving to low-carbon and resilient healthcare systems is increasingly mirrored in discussions of the role of health technology assessment (HTA). This Perspective considers how HTA can most effectively contribute to these goals and where other policy tools may be more effective in driving sustainability, especially given the highly limited pool of resources available to conduct environmental assessments within HTA. It suggests that HTA might most productively focus on assessing those technologies that have intrinsic characteristics which may cause specific environmental harms or vulnerabilities, while the generic environmental impacts of most other products may be better addressed through other policy and regulatory mechanisms.

The purpose of this study was to examine differences in the way Britain and the United States invest in and deploy a new medical technology. We used structured interviews to obtain information on the technical sophistication and approximate replacement value of all hospital-based obstetrical ultrasound machines in every maternity hospital in Washington state and Wales. The supply of hospital-based ultrasound machines—approximately two machines per 1,000 births—was similar in both countries. Wales had fewer advanced ultrasound machines than Washington state, and they were based exclusively in high-volume district general hospitals; there were no obstetric ultrasound machines in the private sector. In Washington state, the majority of advanced machines were in small and medium-sized hospitals, and many private offices had ultrasound machines. The approximate replacement value of hospital-based machines was three times as high per birth in Washington state as in Wales. In the case of obstetrical ultrasound, centralization of facilities, a relatively small private sector, and global budgeting lead to lower expenditures per patient within the National Health Service without compromising access to care.

Medical education in the United States is torn between its allegiance to the Newtonian biomolecular paradigm of medical science that made it so successful in the past and a growing sense, both within academia and without, that medicine needs to become more interdisciplinary and population based. This article explores the potential of the Oxford Perinatal Care model as a useful tool for medical educators to bridge the curricular gap between these two paradigms. The Oxford model is based upon ongoing meta-analysis of all randomized control trials relating to perinatal medicine; interventions and technologies are placed into one of four categories, ranging from “forms of care that reduce negative outcomes” to “forms of care that should be abandoned.” This article proposes a strategy for the inclusion of this information into the U.S. medical school curriculum.

Objectives: Evaluation is essential for the management of international projects or networks in health technology assessment (HTA). It extends beyond the normal process of project management by incorporating qualitative dimensions and provides information about a project's effectiveness and achievements. This article aimed to identify the factors that are important for the success of international HTA projects. The European network for Health Technology Assessment Joint Action (EUnetHTA JA) is presented as an exemplar.

Methods: Methods for the evaluation of international HTA projects include interviews, focus groups, questionnaires, observations and documentary review, and the key points of these approaches have been summarized. The impact and effectiveness of the EUnetHTA JA was evaluated by questionnaires of project participants and external stakeholders, and by documentary review.

Results: The response rate for the three annual questionnaires sent to project participants ranged from 86 percent to 88 percent and for external stakeholders ranged from 65 percent to 88 percent. Key factors for project success included production of deliverables according to the workplan, achievement of objectives, added value generated, effective communication, involvement of external stakeholders, workstream management and progress from the preceding EUnetHTA 2006–2008 project.

Conclusions: The experience of this project can inform the evaluation of future international HTA collaborations, such as the EUnetHTA 2nd Joint Action and HTAsiaLink. A high response rate was achieved to the self-completion questionnaires and the strategy followed is recommended for evaluation of international HTA projects. Future assessments of international HTA projects should strive to measure outcomes and impact, not just outputs and process.

In this issue of the Journal, Panteli et al. (6) provide insight into the extent to which a gender-sensitive approach is adopted by sixty health technology assessment (HTA) agencies worldwide. Their findings should make all of us involved in the production of HTA take pause: less than a handful of the agency Web sites that were examined by Panteli's team made any mention of gender as an explicit consideration in priority setting processes or in the HTA methods used (6). This is despite the fact that gender is recognized as a social determinant of health (1) and despite best practices that acknowledge the need to account for equity issues—of which gender is one—in the design, conduct, and reporting of HTA (3;4). Assuming we take the findings of Panteli et al. at face value, this does seem to be a case of “do as I say, not as I do.”

Any new technology that promises significant costs as well as potential benefits generates considerable interest. Such innovations bring into bold relief the fundamental problem of achieving maximal medical benefits while efficiently and equitably allocating scarce resources (II). Two tools that decision makers can use to assess the benefits and costs of implementing new technologies are cost- benefit analysis (CBA) and cost-effectiveness analysis (CEA). One technology that seems especially appropriate for the application of CBA and CEA is nuclear magnetic resonance (NMR) imaging.

Objectives: Real-time virtual sonography (RVS) is a promising navigation technique for percutaneous radiofrequency ablation (RFA) treatment, especially in ablating nodules poorly visualized on conventional ultrasonography (US). However, its cost-effectiveness has not been established. The purpose of this study is to evaluate the cost-effectiveness of RVS navigated RFA (RVS-RFA) relative to US guided RFA (US-RFA) in patients with small hepatocellular carcinoma (HCC) in China, from the modified societal perspective.

Methods: A state-transition Markov model was created using TreeAge Pro™ 2012. The parameters used in the model, including natural history of HCC patients, procedure efficacy and related costs, were obtained from a systematic search of literature through PubMed, EMBASE, and Science Citation Index databases. The simulated cohort was patients with solitary, small HCC (<3 cm in diameter) and Child-Pugh class A or B, whose tumors are poorly visualized in B-mode US but clearly detectable by CT or MRI.

Results: In this cohort of difficult cases, RVS-RFA was a preferred strategy saving 2,467 CNY ($392) throughout the patient's life while gaining additional 1.4 QALYs compared with conventional US guidance. The results were sensitive to the efficacy of US-RFA and RVS-RFA including complete ablation rate and local recurrence rate, the median survival for patients with progressive HCC, the probability of performing RFA for recurrent HCC, and the cost of RVS navigation, disposable needle or hospitalization.

Conclusions: RVS-RFA is a dominant strategy for patients with small HCC unidentifiable in B-mode US, in terms of cost savings and QALYs gained, relative to the conventional US-guided method.