International journal of technology assessment in health care
-
Int J Technol Assess Health Care · Jan 1998
Evidence into practice. Prescribing selective serotonin reuptake inhibitors.
This descriptive analysis examines prescribing trends of antidepressants in English primary care, providing analysis of NHS reimbursement data for groups of antidepressants between 1989 and 1994. Prescribing trends seem unaffected by the release of information on the effectiveness and cost-effectiveness of antidepressant drugs. We found that simple distribution of the results of health technology assessments may not be sufficient to influence practice.
-
Int J Technol Assess Health Care · Jan 1998
Randomized Controlled Trial Multicenter Study Clinical TrialEconomic analysis of tirilazad mesylate for aneurysmal subarachnoid hemorrhage. Economic evaluation of a phase III clinical trial in Europe and Australia.
This study used data from a multinational phase III randomized, double-blind, vehicle-controlled trial to evaluate the cost-effectiveness of tirilazad mesylate (Freedox) in the treatment of aneurysmal subarachnoid hemorrhage. In men, therapy with 6 mg/kg per day of tirilazad mesylate was associated with significantly increased survival, increased cost of care, and ratios of cost per death averted that compare favorably with the ratios of other life and death interventions. In women, it appeared to have no effects on costs or survival. Further clinical studies may provide additional information about the cost-effectiveness of this intervention.
-
Int J Technol Assess Health Care · Jan 1998
Assessing the predictive validity of the RAND/UCLA appropriateness method criteria for performing carotid endarterectomy.
We assessed the predictive validity of an expert panel's ratings of the appropriateness of carotid endarterectomy by comparing ratings to the results of subsequent randomized clinical trials. We found the trials confirmed the ratings for 44 indications (covering almost 30% of operations performed in 1981) and refuted the ratings for none.
-
Int J Technol Assess Health Care · Jan 1998
Historical ArticleMedical malpractice in twentieth century United States. The interaction of technology, law and culture.
Although medical malpractice litigation in the United States has generated extensive professional and scholarly attention, few analyses of the issue have explored its underlying causes. This essay develops and employs an historical framework to explain the late 20th century phenomenon and concludes that widespread medical malpractice suits are the result of a combination of short-term topical causes and long-term cultural changes that are ignored or left untouched by most reform efforts. Most importantly, however, the development and proliferation of new and improved medical technologies has played a pivotal role throughout the entire history of the litigation, an effect that has become most prominent and important in the last third of the 20th century.