A health care program may influence both costs and health effects. We developed the Health and Labor Questionnaire (HLQ), which consists of four modules, to collect data on absence from work, reduced productivity, unpaid labor production, and labor-related problems. We applied the HLQ in several studies, and the results are encouraging.

A cost-effectiveness model was developed to compare simultaneous pancreas-kidney transplantation (SPK) to kidney transplantation alone (KTA) with continued insulin therapy among type-1 diabetics with end-stage renal disease. It appeared that the two procedures were equally cost-effective only for diabetics whose annual costs for treatment of complications of hyper-and were quite high.

We reviewed economic evaluations of information technology (IT) applications in health care in the United States. National estimates suggest that fully automating administrative functions would save the system $5 to $8 billion per year. Hospital-specific estimates suggest that individual facilities could save $0.5 to $3 million annually from various clinical IT applications.

The protein A immunoadsorption column is a new treatment for immune thrombocytopenic purpura (ITP). We used a decision-analytic approach with a Markov process to model the cost effectiveness of this treatment compared with splenectomy for steroid-resistant ITP patients. Data informing the model were obtained from published literature, a panel of physicians, and public databases. We found initial treatment with the protein A immunoadsorption column to be less expensive and more effective than initial treatment with splenectomy.

Attempts to perform economic reviews of randomized controlled trials frequently lack a systematic approach. This conclusion is consistent with the findings of previous analyses of review articles in other fields, which have highlighted the failure to apply the same degree of rigor to this type of research synthesis that the scientific community has come to expect from primary research articles.

The U.S. National Institutes of Health (NIH) Consensus Development Program (CDP) Guidelines have undergone some modifications over the program's 18-year history. They have never been published in archival form. This article reviews the evolution of the NIH CDP Guidelines and then presents the complete 1995 version.

There is much variation in the provision of clinical pharmacy services in U.K. National Health Service hospitals. Some services are provided in groups and there are differences in the extent to which barriers exist to the provision of services. Factors that linked services included efficient use of resources; barriers involved a requirement for pharmacists to participate in multidisciplinary teams. The strong resemblances between service uptake by hospital pharmacies and the technology diffusion model provides insight into the future development of services in this era of evidence-based care.

This study examines, on a per-case basis, the social costs associated with contraceptive failures and resulting term pregnancies. To combat unintended pregnancy and escalating health care costs, the public sector needs to provide greater access to highly effective methods of contraception.

Changing compliance with medication directives can greatly affect health outcomes. To assess programs that influence compliance, accurate measurement of compliance is essential. All currently available methods are imperfect. This paper suggests a new method—the “randomized response interview”—along with a strategy for its implementation.

Health technology assessment has predominantly been carried out by scientific and health policy experts, but the involvement of users is becoming increasingly important. At present, robust examples of the integration of lay knowledge in health technology assessment are limited, but examination of examples in other fields of health policy decision making can provide important pointers for the development of valid methodologies.

The use of cardiac catheterization procedures and the number of hemodynamic laboratories in Italy increased steadily from 1983 through 1993, sometimes with no planning or modern technology assessment. It is recommended that in the future funds be assigned to improve underused laboratories rather than to build new facilities.