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Economic Evaluation of Diagnostic Technology: Methodological Challenges and Viable Solutions

Published online by Cambridge University Press:  10 March 2009

Franco Sassi
Affiliation:
The London School of Economics and Political Science
Martin McKee
Affiliation:
The London School of Hygiene and Tropical Medicine
Jennifer A. Roberts
Affiliation:
The London School of Hygiene and Tropical Medicine

Abstract

The principles of economic evaluation are increasingly accepted by clinicians and policy makers as evidence from a significant number of studies becomes available to support their decisions. However, methods of assessment still need to be improved. This paper reports a comprehensive review of methodological challenges in the economic evaluation of diagnostic technology, where such challenges are more evident. This review formed the basis for a prioritized research agenda, with four main areas: modeling techniques for dealing with complexity; measures of the opportunity cost of shared resources; techniques for eliciting decision makers' utility functions for diagnostic tests; and ways of assessing the robustness of decisions. A number of methodoligical solutions are proposed, aimed at capturing elements and relationships that are usually neglected and fully recognizing the presence of an inductive cognitive component in decision-making processes.

Type
General Essays
Copyright
Copyright © Cambridge University Press 1997

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References

REFERENCES

1.Adams, M. E., McCall, N. T., Gray, D. T., et al. Economic analysis in randomized control trials. Medical Care, 1992, 30, 231–43.CrossRefGoogle ScholarPubMed
2.Arthur, W. B.Inductive reasoning and bounded rationality. American Economic Review, 1994, 84, 406–11.Google Scholar
3.Asch, D. A., Patton, J. P., & Hershey, J. C.Knowing for the sake of knowing: The value of prognostic information. Medical Decision Making, 1990, 10, 4757.CrossRefGoogle ScholarPubMed
4.Banta, H. D., & McNeil, B. J.Evaluation of the CAT scanner and other diagnostic technologies. Health Care Management Review, 1978, 4, 719.CrossRefGoogle Scholar
5.Barger-Lux, M. J., & Heaney, R. P.For better and worse: The technological imperative in health care. Social Science and Medicine, 1986, 22, 1313–20.CrossRefGoogle ScholarPubMed
6.Begg, C. B.Biases in the assessment of diagnostic tests. Statistics in Medicine, 1987, 6, 411–23.CrossRefGoogle ScholarPubMed
7.Bekker, H., Denniss, G., Modell, M., et al. The impact of population based screening for carriers of cystic fibrosis. Journal of Medical Genetics, 1994, 31, 364–68.CrossRefGoogle ScholarPubMed
8.Bell, D. E.Regret in decision making under uncertainty. Operational Research, 1982, 30, 961–81.CrossRefGoogle Scholar
9.Bell, D. E.Disappointment in decision making under uncertainty. Operational Research, 1985, 33, 127.CrossRefGoogle Scholar
10.Berwick, D. M., Fineberg, H. V., & Weinstein, M. C.When doctors meet numbers. American Journal of Medicine, 1981, 71, 991–98.CrossRefGoogle ScholarPubMed
11.Berwick, D. M., & Weinstein, M. C.What do patients value? Willingness to pay for ultrasound in normal pregnancy. Medical Care, 1985, 23, 881–93.CrossRefGoogle ScholarPubMed
12.Best, G., Parston, G., & Rosenhead, J.Robustness in practice: The regional planning of health services. Journal of the Operational Research Society, 1986, 37, 463–78.Google ScholarPubMed
13.Casscells, W., Schoenberger, A., & Graboys, T. B.Interpretation by physicians of clinical laboratory results. New England Journal of Medicine, 1978, 299, 9991001.CrossRefGoogle ScholarPubMed
14.Christensen-Szalanski, J. J. J. Improving the practical utility of judgment research. In Bremer, B., Jungermann, H., Lourens, P. & Sevon, G. (eds.), New directions in research on decision making New York: North Holland, 1986.Google Scholar
15.Coughlin, S. S., Trock, B., Criqui, M. H., et al. The logistic modeling of sensitivity, specificity, and predictive value of a diagnostic test. Journal of Clinical Epidemiology, 1992, 45, 17.CrossRefGoogle ScholarPubMed
16.Coyle, D., Increasing the impact of economic evaluations on health care decision-making, CHE Discussion Paper 108, York: University of York, 1993.Google Scholar
17.Crystal, R. A., & Brewster, A. W.Cost benefit and cost effectiveness analyses in the health field: An introduction. Inquiry, 1966, 3, 313.Google Scholar
18.Culyer, A. J.Health service efficiency: Appraising the appraisers. Discussion Paper 10, York: University of York, Centre for Health Economics, 1985.Google Scholar
19.Detmer, D. E., Fryback, D. G., & Gassner, K.Heuristics and biases in medical decisionmaking. Journal of Medical Education, 1978, 53, 682–83.Google Scholar
20.Detsky, A. S., Redelmeier, D., & Abrams, H. B.What's wrong with decision analysis? Can the left brain influence the right? Journal of Chronic Diseases, 1987, 40, 831–38.CrossRefGoogle ScholarPubMed
21.Diamond, G. A.Clinical epistemology of sensitivity and specificity. Journal of Clinical Epidemiology, 1992, 45, 913.CrossRefGoogle ScholarPubMed
22.Drummond, M. F.Evaluation of health technology: Economic issues for health policy and policy issues for economic appraisal. Social Science and Medicine, 1994, 38, 1593–600.CrossRefGoogle ScholarPubMed
23.Drummond, M. F., Ludbrook, A., Lowson, K., & Steele, A.Studies in economic appraisal in health care. Oxford: Oxford University Press, 1986.Google Scholar
24.Drummond, M. F., Stoddart, G., & Torrance, G.Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press, 1987.Google Scholar
25.Dyer, J. S., & Sarin, R. K.Measurable multiattribute value functions. Operational Research, 1979, 27, 810–22.CrossRefGoogle Scholar
26.Dyson, R. G.Viewpoint: Robustness and optimality as criteria for decisions. Operational Research Quarterly, 1973, 24, 317–18.CrossRefGoogle Scholar
27.Eddy, D. M.Screening for cancer: Theory, analysis and design. Englewood Cliffs, NJ: Prentice-Hall 1980.Google Scholar
28.Eddy, D. M., & Clanton, C. H.The art of diagnosis: Solving the clinicopathological exercise. New England Journal of Medicine, 1982, 306, 1263–68.CrossRefGoogle ScholarPubMed
29.Eisenberg, J. M., & Nicklin, D.Use of diagnostic services by physicians in community practice. Medical Care, 1981, 19, 297309.CrossRefGoogle ScholarPubMed
30.Epstein, A. M., Begg, C. B., & McNeil, B. J.The effects of physicians' training and personality on test ordering for ambulatory patients. American Journal of Public Health 1984, 74, 1271–73.CrossRefGoogle ScholarPubMed
31.Epstein, A. M., Begg, C. B., & McNeil, B. J.The use of ambulatory testing in prepaid and fee-for-service group practices: Relation to perceived profitability. New England Journal of Medicine, 1986, 314, 1089–94.CrossRefGoogle ScholarPubMed
32.Escarce, J.Medicare patients' use of overpriced procedures before and after the Omnibus Budget Reconciliation Act of 1987. American Journal of Public Health, 1993, 833, 4955.Google Scholar
33.Escarce, J. J., Bloom, B. S., Hillman, A. L., et al. Diffusion of laparoscopic cholecystectomy among general surgeons in the United States. Medical Care, 1995, 33, 256–71.CrossRefGoogle ScholarPubMed
34.Feinstein, A. R.Clinical judgment. Baltimore, MD: Williams and Wilkins, 1967.Google Scholar
35.Feldman, W.How serious are the adverse effects of screening? Journal of General Internal Medicine, 1990, 5(suppl.), 850–53.CrossRefGoogle ScholarPubMed
36.Feussner, J. R., & Matchar, D. B.When and how to study the carotid arteries. Annals of Internal Medicine, 1988, 109, 805–18.CrossRefGoogle Scholar
37.Fineberg, H. V., Bauman, R., & Sosman, M.Computerized cranial tomography: Effect on diagnostic and therapeutic plans. Journal of the American Medical Association, 1977, 238, 224–27.CrossRefGoogle ScholarPubMed
38.Fraser-Hill, M. A., Renfrew, D. L., & Hilsenrath, P. E.Percutaneous needle biopsy of musculoskeletal lesions, 2: Cost-effectiveness. American Journal of Roentgenology, 1992, 158, 813–18.CrossRefGoogle ScholarPubMed
40.Fuchs, V. R.The growing demand for medical care. New England Journal of Medicine, 1968, 279, 190–95.CrossRefGoogle ScholarPubMed
41.Gabel, J. R., & Redisch, M. A.Alternative physician payment methods: Incentives, efficiency and national health insurance. Milbank Memorial Quarterly, 1979, 57, 3859.CrossRefGoogle ScholarPubMed
42.Gafni, A., & Birch, S.Guidelines for the adoption of new technologies: A prescription for uncontrolled growth in expenditures and how to avoid the problem. Canadian Medical Association Journal, 1993, 148, 913–17.Google ScholarPubMed
43.Gerard, K.Cost-utility in practice: A policy maker's guide to the state of the art. Health Policy, 1992, 21, 249–80.CrossRefGoogle ScholarPubMed
44.Glaser, W. A.Paying the doctor: Systems of remuneration and their effects. Baltimore, MD: John Hopkins University Press, 1970.Google Scholar
45.Godyn, J. J., Tomaszewski, J. E., & Zmijewski, C. M.Specificity of a reproducible qualitative urine examination is not a constant test characteristic. American Journal of Clinical Pathology, 1991, 95, 265–66.CrossRefGoogle Scholar
46.Grover, S. A., Abrahamowicz, M., Joseph, L., et al. The benefits of treating hyperlipidemia to prevent coronary heart disease. Journal of the American Medical Association, 1992, 267, 816–22.CrossRefGoogle ScholarPubMed
47.Gunning-Schepers, L.The health benefits of prevention. Rotterdam: Institut Maatschappelijke Gezondheidszorg, Erasmus Universiteit, 1988.Google Scholar
48.Gupta, S. K., & Rosenhead, J.Robustness in sequential investment decisions. Management Sciences, 1968, 15, 1829.CrossRefGoogle Scholar
49.Guyatt, G., & Drummond, M. F.Guidelines for the clinical and economic assessment of health technologies: The case of magnetic resonance. International Journal of Technology Assessment in Health Care, 1985, 1, 551–66.CrossRefGoogle ScholarPubMed
50.Guyatt, G. H., Tugwell, P. X., Feeny, D. H., et al. A framework for clinical evaluation of diagnostic technologies. Canadian Medical Association Journal, 1986, 134, 587–94.Google ScholarPubMed
51.Guyatt, G. H., Tugwell, P. X., Feeny, D. H., et al. The role of before-after studies of therapeutic impact in the evaluation of diagnostic technologies. Journal of Chronic Diseases, 1986, 39, 295304.CrossRefGoogle ScholarPubMed
52.Hanley, J. A., & McNeil, B. J.The meaning and use of the area under a receiver operating characteristics (ROC) curve. Radiology, 1982, 143, 2936.CrossRefGoogle Scholar
53.Hasselblad, V., & Hedges, L. V. Meta-analysis of screening or diagnostic tests. Psychological Bulletin, in press.Google Scholar
54.Haynes, R. B., Sackett, D. L., Taylor, D. W., et al. Increased absenteeism from work after detection and labelling of hypertension patients. New England Journal of Medicine, 1978, 229, 741–44.CrossRefGoogle Scholar
55.Heise, D. R.Causal analysis. New York: Wiley, 1975.Google Scholar
56.Hickson, G. B., Altemeier, W. A., & Perrin, J. M.Physician reimbursement by salary or fee-for-service: Effect on physician practice behavior in a randomized prospective study. Pediatrics, 1987, 80, 344–50.CrossRefGoogle ScholarPubMed
57.Hlatky, M. A., Pryor, D. B., Harrel, F. E., et al. Factors affecting sensitivity and specificity of exercise electrocardiography. American Journal of Medicine, 1984, 77, 6471.CrossRefGoogle ScholarPubMed
58.Holtgrave, D. R., Lawler, F., & Spann, S. J.Physicians' risk attitudes, laboratory usage, and referral decisions: The case of an academic family practice center. Medical Decision Making, 1991, 11, 125–30.CrossRefGoogle ScholarPubMed
59.Hurley, J., & Labelle, R.Relative fees and the utilization of physicians' services in Canada. Working Paper 94–6, Hamilton: McMaster University, Centre for Health Economics and Policy Analysis, 1994.Google Scholar
60.Hurley, J., Labelle, R., & Rice, T. The relationship between physician fees and utilization of medical services in Ontario. In Scheffler, R., & Rossiter, L. (eds.), Advances in health economics and health services research. Greenwich, CT:JAI Press, 1990.Google Scholar
61.Hutton, J. Economic appraisal of health technology: A review of the current state of the art in EC countries. In Drummond, M. F. (ed.), Economic appraisal of health technology in the European Community. Oxford: Oxford Medical Publications, 1987.Google Scholar
62.Jaime Caro, J., Trindade, E., & McGregor, M.The cost-effectiveness of replacing highosmolality with low-osmolality contrast media. American Journal of Roentgenology, 1992, 159, 869–74.CrossRefGoogle Scholar
63.Johanson, J. F., & Sonnenberg, A.Efficient management of diarrhea in the acquired immunodeficiency syndrome (AIDS): A medical decision analysis. Annals of Internal Medicine, 1990, 112, 942–48.CrossRefGoogle ScholarPubMed
64.Johnson, H. A.Predictive value and informational value of diagnostic test results. Annals of Clinical and Laboratory Sciences, 1993, 23, 159–64.Google ScholarPubMed
65.Kahneman, D., & Tversky, A.Prospect theory: An analysis of decision under risk. Econometrica, 1979, 47, 263–91.CrossRefGoogle Scholar
66.Kassirer, J. P.Diagnostic reasoning. Annals of Internal Medicine, 1989, 110, 893900.CrossRefGoogle ScholarPubMed
67.Kassirer, J. P.Our stubborn quest for diagnostic certainty: A cause of excessive testing. New England Journal of Medicine, 1989, 320, 1489–91.CrossRefGoogle ScholarPubMed
68.Kassirer, J. P., & Gorry, G. A.Clinical problem solving: A behavioral analysis. Annals of Internal Medicine, 1978, 89, 245–55.CrossRefGoogle ScholarPubMed
69.Kassirer, J. P., & Kopelman, R. I.Cognitive errors in diagnosis: Instantiation, classification, and consequences. American Journal of Medicine, 1989, 86, 433–41.CrossRefGoogle ScholarPubMed
70.Keeney, R. L., & Raiffa, H.Decisions with multiple objectives. New York: John Wiley, 1976.Google Scholar
71.Klarman, H. E.Present status of cost-benefit analysis in the health field. American Journal of Public Health, 1967, 57, 1948–53.CrossRefGoogle ScholarPubMed
72.Lashner, B. A., & Silverstein, M. D.Evaluation and therapy of the patient with fecal occult blood loss: A decision analysis. American Journal of Gastroenterology, 1990, 85, 1088–95.Google Scholar
73.Laupacis, A., Feeny, D., Detsky, A. S., & Tugwell, P. X.How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. Canadian Medical Association Journal, 1992, 146, 473–81.Google ScholarPubMed
74.Laupacis, A., Feeny, D., Detsky, A. S., & Tugwell, P. X.Tentative guidelines for using clinical and economic evaluations revisited. Canadian Medical Association Journal, 1993, 148, 927–29.Google ScholarPubMed
75.Lave, J. R., Pashos, C. L., Anderson, G. F., et al. Costing medical care: Using Medicare administrative data. Medical Care, 1994, 32 (suppl.7), js77–js89.CrossRefGoogle ScholarPubMed
76.Lee, J. T., & Sanchez, L. A.Interpretation of ‘cost-effective’ and soundness of economic evaluations in the pharmacy literature. American Journal of Hospital Pharmacy, 1991, 48, 2622–27.Google ScholarPubMed
77.Luce, B. R., & Elixhauser, A.Estimating costs in the economic evaluation of medical technologies. International Journal of Technology Assessment in Health Care, 1990, 6, 5775.CrossRefGoogle ScholarPubMed
78.McNeil, B. J., Keller, E., & Adelstein, S. J.Primer on certain elements of medical decision making. New England Journal of Medicine, 1975, 293, 211–15.CrossRefGoogle ScholarPubMed
79.Mooney, G.What else do we want from our health services? Social Science and Medicine, 1994, 39, 151–54.CrossRefGoogle ScholarPubMed
80.Mooney, G., & Lange, M.Ante-natal screening: What constitutes ‘benefit’? Social Science and Medicine, 1993, 37, 873–78.CrossRefGoogle ScholarPubMed
81.Moskowitz, A. J., Kuipers, B. J., & Kassirer, J. P.Dealing with uncertainty, risks and tradeoffs in clinical decisions. Annals of Internal Medicine, 1988, 108, 435–49.CrossRefGoogle ScholarPubMed
82.Mulkay, M., Ashmore, M., & Pinch, T. Dependency and dispair: Health economics and the health-care system. In Hutton, J., Hutton, S., Pinch, T., & Shiell, A., (eds.), Dependency to enterprise. London: Routledge, 1991, 207–18.Google Scholar
83.Mushlin, A. I., Mooney, C., Grow, V., & Phelps, C. E.The value of diagnostic information to patients with suspected multiple sclerosis. Archives of Neurology, 1994, 5, 6772.CrossRefGoogle Scholar
84.Mutgi, A., Williams, J. W., & Nettleman, M. D.Renal colic: Utility of the plain abdominal roentgenogram. Archives of Internal Medicine, 1991, 151, 1589–92.CrossRefGoogle ScholarPubMed
85.Naylor, C. D., Williams, J. I., Basinski, A., & Goel, V.Technology assessment and cost-effectiveness: Misguided guidelines? Canadian Medical Association Journal, 1993, 148, 921–24.Google ScholarPubMed
86.Nightingale, S. D.Risk preference and laboratory use. Medical Decision Making, 1987, 7, 168–72.CrossRefGoogle ScholarPubMed
87.Nightingale, S. D.Risk preference and admitting rates of emergency room physicians. Medical Care, 1988, 26, 8487.CrossRefGoogle ScholarPubMed
88.Nightingale, S. D., Yarnold, P. R., & Greenberg, M. S.Sympathy, empathy, and physician resource utilization. Journal of General Internal Medicine, 1991, 6, 420–23.CrossRefGoogle ScholarPubMed
89.O'Connor, P., Detsky, A. S., Tansey, C., Kucharczyk, W., & The Rochester-Toronto MRI Study Group. Effects of diagnostic testing for multiple sclerosis on patient health perceptions. Archives of Neurology, 1994, 51, 4651.CrossRefGoogle ScholarPubMed
90.Oliver, R. M., & Smith, J. Q. (eds.). Influence diagrams, belief nets and decision analysis. Chichester: John Wiley, 1989.Google Scholar
91.Ornstein, S. M., Markert, G. P., Johnson, A. H., et al. The effect of physician personality on laboratory test ordering for hypertensive patients. Medical Care, 1988, 26, 536–43.CrossRefGoogle ScholarPubMed
92.Pauker, S. G., & Kassirer, J. P.The threshold approach to clinical decision making. New England Journal of Medicine, 1980, 302, 1109–17.CrossRefGoogle ScholarPubMed
93.Poses, R. M., Cebul, R. D., & Wigton, R. S.You can lead a horse to water: Improving physicians' knowledge of probabilities may not affect their decisions. Medical Decision Making, 1995, 15, 6575.CrossRefGoogle Scholar
94.Ramoni, M., Stefanelli, M., Magnani, L., & Barosi, G.An epistemological framework for medical knowledge-based systems. IEEE Transactions on Systems, Man and Cybernetic 1992, 22, 1361–74.CrossRefGoogle Scholar
95.Ranshoff, D. F., & Feinstein, A. R.Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. New England Journal of Medicine, 1978, 299, 926–30.CrossRefGoogle Scholar
96.Rembold, C. M., & Watson, D.Posttest probability calculation by weights. Annals of Internal Medicine, 1988, 108, 115–20.CrossRefGoogle ScholarPubMed
97.Ried, W.Willingness to pay for diagnostic services: A new approach to modelling patient benefits in health care. Health Economics, 1994, 3, 255–66.CrossRefGoogle ScholarPubMed
98.Rosenhead, J.Operational research in health services planning. European Journal of Operational Research, 1978, 2, 7585.CrossRefGoogle Scholar
99.Rosenhead, J. Robustness analysis: Keeping your options open. In Rosenhead, J. (ed.), Rational Analysis in a problematic world, Chichester: John Wiley, 1989.Google Scholar
100.Rosenhead, J., Elton, M., & Gupta, S. K.Robustness and optimality as criteria for strategic decisions. Operational Research Quarterly, 1972, 23, 413–31.CrossRefGoogle Scholar
101.Rozanski, A., Diamond, G. A., Berman, D., et al. The declining specificity of exercise radionuclide ventriculography. New England Journal of Medicine, 1983, 309, 518–22.CrossRefGoogle ScholarPubMed
102.Ruwe, P. A., Wright, J., Randall, R. L., et al. Can MR imaging effectively replace diagnostic arthroscopy? Radiology, 1992,183, 335–39.CrossRefGoogle ScholarPubMed
103.Shickle, D., & Chadwick, R.The ethics of screening: Is ‘screeningitis’ an incurable disease? Journal of Medical Ethics, 1994, 20,1228.CrossRefGoogle ScholarPubMed
104.Silk, A. D.Our stubborn quest for diagnostic certainty [letter: relpy to Kassirer]. New England Journal of Medicine, 1989, 321,1272.Google Scholar
105.Simel, D. L., Samsa, G. P., & Matchar, D. B.Likelihood ratios for continuous test results: Making the clinicians' job easier or harder? Journal of Clinical Epidemiology, 1992, 46, 8593.CrossRefGoogle Scholar
107.Sonnenberg, F. A., Roberts, M. S., Tsevat, J., et al. Toward a peer review process for medical decision analysis models. Medical Care, 1994, 32(suppl.7), js52–js64.CrossRefGoogle Scholar
108.Sox, H. C., Margulies, I., & Sox, C. H.Psychologically mediated effects of diagnostic tests. Annals of Internal Medicine, 1981, 95, 680–85.CrossRefGoogle ScholarPubMed
109.Sutherland, S.Irrationality, Harmondsworth; Penguin, 1994.Google Scholar
110.Swan, I. R. C., & Gatehouse, S.Clinical and financial audit of diagnostic protocols for lesions of the cerebellopontine angle. British Medical Journal, 1991, 302, 701–04.CrossRefGoogle ScholarPubMed
111.Swets, J. A.Measuring the accuracy of diagnostic systems. Science, 1988, 240, 1285–93.CrossRefGoogle ScholarPubMed
112.Swets, J. A., Pickett, R. M., Whitehead, S. F., et al. Assessment of diagnostic technologies. Science, 1979, 205, 753–59.CrossRefGoogle ScholarPubMed
113.Szczepura, A. K., Fletcher, J., & Fitz-Patrick, J. D.Cost effectiveness of magnetic resonance imaging in the neurosciences. British Medical Journal, 1991, 303, 1435–39.CrossRefGoogle ScholarPubMed
114.Thompson, S. G.Why sources of heterogeneity in meta-analyses should be investigated. British Medical Journal, 1994, 309, 1351–55.CrossRefGoogle ScholarPubMed
115.Torrance, G. W., Boyle, M. H., & Horwood, S. P.Applications of multi-attribute utility theory to measure social preferences for health states. Operational Research, 1982, 30, 1043–69.CrossRefGoogle ScholarPubMed
116.Torrance, G. W., Zhang, Y., Feeny, D., et al. Multi-attribute preference functions for a comprehensive health status classification system. Working Paper 92–18. Hamilton: McMaster University, Centre for Health Economics and Policy Analysis, 1992.Google Scholar
117.Tsevat, J., Wong, J. B., Pauker, S. G., & Steinberg, M. H.Neonatal screening for sickle cell disease: A cost-effectiveness analysis. Journal of Pediatrics, 1991, 118, 546–54.CrossRefGoogle ScholarPubMed
118.Tversky, A., & Kahneman, D.Judgment under uncertainty: Heuristics and biases. Science, 1974, 185, 1124–31.CrossRefGoogle ScholarPubMed
119.Udvarhelyi, I. S., Colditz, G. A., Rai, A., & Epstein, A. M.Cost-effectiveness and cost-benefit analyses in the medical literature: Are the methods being used correctly? Annals of Internal Medicine, 1992, 116, 238–44.CrossRefGoogle ScholarPubMed
106.Somoza, E., & Mocsman, D.Comparing and optimizing diagnostic tests: An information theoretical approach. Medical Decision Making, 1992, 12, 179–88.CrossRefGoogle ScholarPubMed
120.Wack, P.Scenarios: Uncharted waters ahead. Harvard Business Review, 1985, 63, 7389.Google Scholar
121.Wagner, J. L.The feasibility of economic evaluation of diagnostic procedures. Social Science and Medicine, 1983, 17, 861–69.CrossRefGoogle ScholarPubMed
122.Wagner, J. L.Economic evaluation in neuroradiology. Journal of Neuroradiology, 1983, 10, 96100.Google ScholarPubMed
123.Walt, G.How far does research influence policy? European Journal of Public Health, 1994, 4, 233–35.CrossRefGoogle Scholar
124.Weinstein, M. C.Methodologic considerations in planning clinical trials of cost-effectiveness of magnetic resonance imaging. International Journal of Technology Assessment in Health Care, 1985, 1, 567–81.CrossRefGoogle ScholarPubMed
125.Weinstein, M. C.Challenges for cost-effectiveness research. Medical Decision Making, 1986, 6,194–98.CrossRefGoogle ScholarPubMed
126.Weinstein, M. C., Coxson, P. G., Williams, L. W., et al. Forecasting coronary heart disease incidence, mortality, and cost: The Coronary Heart Disease Policy Model. American Journal of Public Health, 1987, 77, 1417–26.CrossRefGoogle ScholarPubMed
127.Weinstein, M. C., Fineberg, H. V., Elstein, A. S., et al. Clinical decision analysis Philadelphia: Saunders, 1980.Google Scholar
128.Weinstein, M. C., & Stason, W. B.Cost-effectiveness of interventions to prevent or treat coronary heart disease. Annual Review of Public Health, 1985, 6, 4163.CrossRefGoogle ScholarPubMed
129.White, D. J.Viewpoint: Robustness and optimality as criteria for decisions. Operational Research Quarterly, 1973, 24, 311–13.CrossRefGoogle Scholar
130.Wiggins, S., Whyte, P., Huggins, M., et al. , for the Canadian Collaborative Study Group of Predictive Testing. The psychological consequences of predictive testing for Huntington's disease. New England Journal of Medicine, 1992, 327, 1401–05.CrossRefGoogle Scholar
131.Yarnold, P. R., Nightingale, S. D., Curry, R. H., & Martin, G. J.Psychological androgyny and preference in loss-framed gambles of medical students: Possible implications for resource utilization. Medical Decision Making, 1991, 11, 176–79.CrossRefGoogle ScholarPubMed
132.Zaat, J. O. M., & van Eijk, T. M.General practitioners' uncertainty, risk preference, and use of laboratory tests. Medical Care, 1992, 30, 846–54.CrossRefGoogle ScholarPubMed
133.Zylak, C. J., & Gafni, A.A methodologic overview of the evaluation of costs and benefits in diagnostic radiology. Investigative Radiology, 1992, 27, 483–88.CrossRefGoogle ScholarPubMed