Costs and Benefits in Health Care and Prevention: An International Approach to Priorities in Medicine

Abstract

These papers are from a conference held in Bielefeld in June 1988. After an introduction reviewing ethical and practical limitations of how to value health benefits, the first four papers, dealing with concepts, cover: cost-effectiveness analysis (CEA), cost-benefit analysis and the value of life in health care and prevention; CEA in health care - opportunities and challenges to international comparisons; the feasibility of willingness-to-pay measurement in health services research; and caveats to biased application of the willingness-to-pay approach. The contributions in the following part all deal with hypertension: attitude and behaviour of Stuttgart's primary care physicians to pharmacological and non-pharmacological treatment of mild hypertension; comparison of 1977 and 1987 physicians' knowledge survey - implications on cost and hypertension management; evaluation of cost-effectiveness of physician-nurse teams as compared to physicians working alone in primary care practices in community control of hypertension; medical and cost implications of the Ashkelon hypertension detection and control programme; and the management of hypertension - a clinical dilemma with health policy implications. The next part is concerned with the case of clinical disease, with papers on: angina pectoris prophylaxis - a model estimate of cost and benefit; cost considerations for the management of end stage renal disease in the United States; and medical treatment and its implication on costs - an analysis with process data from the German statutory health insurance. Three papers deal with the quality of life: methodological key issues; towards integrated measurement; and quality of life, clinical trials and CEA - conceptual issues with hypertension as an example. The three final contributions are comments on the state of the art: notes on economic evaluation; some limitations in the analysis of costs and benefits; and research perspectives for the future - international cooperation.