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Using cost-effectiveness for subsidy decisions
  1. Department of Social and Preventive Medicine,
  2. Medical School, University of Queensland,
  3. Herston 4006, Australia

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Last century if a patient presented with chest pain or dyspnoea the only laboratory examination we may have considered was a visual inspection of the urine, and the treatment options might have included blood letting and foxglove. Today we enjoy a far greater ability to investigate and treat. This technological luxury has lead to rising health care costs and the consequent need for cost controls, either implicit or explicit. Health care managers may have to consider whether to allow tissue plasminogen activator (t-PA) rather than streptokinase for acute myocardial infarction, which patients should be allowed HMGCoA reductase inhibitors, whether intravascular ultrasound should be available, and what should be the access to coronary bypass, stenting, and angioplasty. The list grows ever longer. An article in this issue asks us to consider abciximab in preventing restenosis after angioplasty in high risk patients.1

Use of cost-effectiveness analyses

Given budgetary limitations, how are we to choose? Commonly this occurs by lobbying from groups interested in the new technology, and the budget is constrained by capping the amount spent in a particular area. Some policy makers are turning to evidence-based medicine, not so much as a means of improving patient care, but as a means of containing costs. Health economists advise us to ask, “is this value for money?” and hence would require a cost-effectiveness analysis …

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