There is no doubt that the U.S. Office of Technology Assessment was the leading body in getting technology assessment (TA) into health care. But it was an idea whose time had come. Several people around the world had all begun to look at the same issues, particularly focusing on the introduction of computed tomography (CT) scanners. I sometimes wonder what would have happened to TA if CT scanners had not appeared just at that time!

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.

Two functions of home care, assistance to improve disabled and aged patients' mobility and function, and self-care that includes treatment, screening-monitoring, exercise assistance, and information exchange, are described, as are the technologies used for these functions. Social and economic pressures as well as professional rationales that expand the use of technologies at home are noted, as is their impact on the site of care and on the patient-doctor relationship.

The purpose of this study was to monitor changes in preoperative routines following recommendations given in 1989 by the Swedish Council on Technology Assessment and by the Swedish Consensus Conference on Preoperative Routines, both suggesting a more individualized utilization of preoperative testing. This was a multicenter, prospective, repetitive study conducted at seven Swedish hospitals providing surgical care. The subjects included all patients presenting at the operating theaters for surgical interventions requiring general or regional anesthesia. The main outcome measures were the frequency of reports of performed preoperative ECG, chest x-ray, and analysis of serum concentration of potassium. Before general recommendations were issued in 1989, 47% of the patients had had a preoperative ECG, 26% had had a chest x-ray, and in 61% serum potassium concentration had been measured. In 1991 these frequencies had been reduced by 5,6, and 9 percentage points, respectively (all figures given standardized for age and sex). Large differences were found between indidividual hospitals. Although recommendations suggesting a more restrictive and individualized utilization of preoperative testing have sparked important revisions in Swedish hospitals, there seems to be substantial potential remaining for further reduction of perfunctory use of preoperative screening.

Technology assessment in health care seeks to evaluate intended and unintended consequences of the use of technology across a broad range that includes health, economic, legal, ethical, and other social implications. In conducting such evaluations, analysts draw on methods and information from an equally broad range of disciplines. The field of technology assessment thus itself conforms to the definition of a technology, that is, the application of knowledge to a purpose.

A literature review compared the results of different kidney function tests using the inulin clearance or similar methods as a gold standard. The methodological strength of the available studies was weak. For the time being, the calculated creatinine clearance using formula, is a first choice, especially in general practice.

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.

Less developed countries (LDCs) are limited in medical resources. Medical technology and the management talent required to handle it play a particularly major role in their national health care and has significant economic, political, and ethical ramifications. This study of the assessment process of medical technology in the LDCs proposes a limited framework for the analysis of the major parameters involved, i.e., stakeholders, boundaries and constraints, goals and objectives, criteria to be met, performance measures, and measurement of performance. The importance of the intangible factors is elucidated.

We examined the use of percutaneous transluminal coronary angioplasty, kidney stone lithotripsy, and bone marrow transplant among patients with different health insurance plans in California. HMO enrollees were less likely to receive these procedures compared with fee-for-service patients. Our results have implications for the inflationary effects of technology under managed care.

Facing intense price competition and societal pressures, health care provider organizations have focused increasingly on the cost-effectiveness of medical services. In instances when there is insufficient evidence that a more expensive treatment course generates improved outcomes, the lower cost option is often encouraged. Yet, with resource utilization still determined principally by individual physicians, large practice variations often persist. This paper reviews the literature and explores the impact of sharing cost information on physicians' practice patterns utilizing management theory concepts. More research should be conducted to determine long-term benefits of educational interventions, physicians' fundamental views on the relationship between cost and quality and its effect on their responsiveness to cost information, and the role of leadership in changing clinical behavior.

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.

A review of 39 articles found no consensus on indication for laparoscopic assisted vaginal hysterectomy (LAVH) compared with traditional approaches. Since only three randomized trials comparing LAVH with traditional methods exist, the scientific basis for surgical choice is lacking. Uncontrolled studies indicated that outcomes following LAVH were not superior to vaginal hysterectomy and costs were significantly higher.

The evaluation of low-cost technologies is complicated by the difficulty of understanding what is meant by “low” cost. Low unit costs may lead to the widespread use of a technology that results in high aggregate costs. It is often more useful to consider the value than the cost of a technology, recognizing that this value may change, depending upon the group to whom it is applied as well as the factors that are measured. Public policy should attempt not only to control costs but also to obtain the greatest value for expenditures in health care by supporting the development of methodologies to define value, reimbursement strategies that emphasize cost-effectiveness, and clinical guidelines that can reduce variation in practice.

The practice of postoperative artificial nutrition (PAN) in elective surgery was covered by a consensus conference in France (December 16,1994). Artificial nutrition was defined as the intake of at least two macronutrients (protein, lipid, and carbohydrate) through an artificial pathway (enteral/parenteral). The guidelines resulting from the conference (2) recommended prescribing artificial nutrition for only malnourished patients, patients with insufficient postoperative nutrient intake lasting 7 or more days, and patients with severe postoperative complications. These were similar to American guidelines produced in 1993 (1).

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.

The extensive benefits of the total hip (THA) and knee (TKA) replacements are well documented, but surprisingly little is known about their economics. We assessed costs, cost-effectiveness (C/E), and patient-related C/E variances in THA and TKA from data on 276 THA and 176 TKA patients. Patients with primary arthrosis, primary operation, and total joint replacement were recruited from seven hospitals between March 1991 and June 1992. Their use of health and other welfare services together with health-related quality of life (HRQoL) were measured before the surgery and at 6, 12, and 24 months postoperatively. HRQoL was assessed by the 15D, a 15-dimensional HRQoL instrument, and the Nottingham Health Profile. Costs were assessed from questionnaire responses, the Finnish Hospital Discharge Register, and Finnish Arthroplasty Register. Total hospital costs per patient were 45,000 FIM (US $10,500) for THA and 49,600 FIM (US $11,500) for TKA. Prosthesis costs comprised 21 % of these costs in THA and 24% in TKA. On average, hip patients gained more in terms of HRQoL, and the operations were more cost-effective. The C/E ratio for younger (« 60 years) knee patients did not differ from those in all age groups of hip patients, whereas TKAs in those over 60 years had a worse C/E ratio compared with all other patient subgroups. It was concluded that allocation efficiency can be improved by considering not only the intervention but also patient characteristics such as age. Indeed, the C/E ratio varied more across age groups of knee patients than between average THA and TKA patients.

Evaluating the impact of computer-based medical information systems requires not only an understanding of computer technology but also an understanding of complex social and behavioral processes. This essay discusses the need for evaluation of health care information systems, a set of evaluation questions based on assumptions about the impact of technology on organizations, and recommendations for reducing barriers to the implementation of health care information systems.

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.