No European country (as far as the author knows) has a comprehensive strategy for technology assessment and implementation. Many countries undertake some aspects of such a strategy, but none cover all of them. Such a strategy would need to include the technical, clinical, economic and social evaluation of technologies, and the use of this information to set policies and to ensure that they are implemented. Despite the considerable differences in health systems financing and organization there is a surprising degree of similarity in the way we approach technology assessment; more variability exists in the mechanisms used to regulate and control the introduction and use of medical technologies.

The objective of this article is to describe and analyze the decision-making process and its consequences for medical technology transfer in China. Data were obtained in 1987 from 35 elite teaching hospitals affiliated with 13 medical universities, directly supervised by the Ministry of Health in the People's Republic of China. This article focuses on three kinds of diagnostic equipment: computerized tomographs, ultrasonic diagnostic units, and high-power x-ray diagnostic apparatuses. Decision-making on the transfer of medical technology in China is decentralized. Most hospitals rely on foreign medical sales representatives and medical exhibits, and their decisions on the acquisition of equipment rely more on the services available than on the price of the product. Chinese hospitals also encounter serious infrastructure problems when buying medical equipment. A number of alternatives are suggested for improving the efficiency of medical technology transfer in China.

Screening has a relevant role in and is likely to become an increasingly important instrument for cancer control in the near future. This overview summarizes some of the available evidence on the issue. Some of the opinions are well established. The apparent absence of consensus on other issues should be critically evaluated, too, because the evidence on some procedures is substantially more convincing than that on others. High costs, low compliance, poor curability, and substantial false positive rates, in a disease as relatively rare as cancer, often counterbalance in practice the theoretical benefits of diagnostic anticipation. In screening as well as in treatment for cancer, it is unlikely that major technical breakthroughs will occur in the near future. The evaluation of whether the benefits likely to be achieved by the screening program outweigh its disadvantages by a sufficient margin, therefore, should rely on large and carefully planned controlled studies.

The assessment of drugs in Sweden has a long tradition that goes back to the seventeenth century when the Collegium Medicorum was established in 1663. One of its duties was to control the production of drugs in pharmacies. In 1688, Sweden got its first pharmacopoeia. In 1917, the Pharmaceutical Laboratory was founded as an advisory body of the National Board of Health and Welfare. The laboratory, now called the Department of Drugs, became responsible for evaluating drug applications, including information on their pharmaceutical and chemical properties, pharmacological actions, and clinical effects.

Orthognathic surgery is a rapidly growing biotechnologic interaction involving alterations of facial form and dental occlusion. This article describes some of the important and complex psychological, sociological, ethical, and public policy issues involved. Advances in the latter issues are necessary for advancement of the field.

The effectiveness of screening to control lung cancer was examined in the German Democratic Republic by analyzing data from a cancer registry and incidence and mortality rates for lung cancer relative to different screening policies, and by two case-control studies. Mortality from lung cancer did not appear to be affected by the screening programs studied. The high cost of mass screening, combined with uncertainty about the benefits of early treatment of lung cancer, outweigh the vague advantages of such screening.

When I was a doctoral student in health care administration at the University of Chicago, I worked with Odin Anderson, who introduced me to Osier Peterson and Bjprn Smedby. Odin first took me to Sweden in 1966. In early 1970, I met Lee Lusted and heard about clinical decision analysis. My interests, then as now, were the costs and outcomes of hospital care, although the methods I have used to address these problems have varied over time.

Pragmatic or practice-oriented comparative effectiveness trials may be conducted to fill the evidence gaps that are revealed after the private sector has performed the trials needed for bringing their product to the market. A tool of increasing importance to identify such evidence gaps is resulting from health technology assessments (HTA) whereby the data derived from clinical research are examined in a systematic manner with reference to effect, safety, as well as additional parameters. Practice-oriented trials are informative for healthcare decision makers, practice-changing and may even be cost-saving for the healthcare payers. There are however only a limited number of funding sources for such trials. Public and private healthcare payers should stimulate the conduct of practice-oriented trials in their effort to maximize patient benefit within the limitation of the available resources. Pragmatic randomized trials can be performed at low cost when based on existing coded electronic health records and as well health registries. Public health decision makers are increasingly taking advantage of results from health technology assessments to support priority setting. In accordance with this it would appear reasonable that decision makers should get more involved in priority setting and funding also in the field of clinical research in order to provide further evidence needed for assessments, reassessments, and subsequent qualified decisions and resource allocations in health care. A closer dialogue and collaboration between the clinical research and HTA communities would facilitate a more efficient utilization of such opportunities.

Background: The aim of this study was to assess the quality of reporting sample size calculation and underlying design assumptions in pivotal trials of high-risk medical devices (MDs) for neurological conditions.

Methods: Systematic review of research protocols for publicly registered randomized controlled trials (RCTs). In the absence of a published protocol, principal investigators were contacted for additional data. To be included, trials had to investigate a high-risk MD, registered between 2005 and 2015, with indications stroke, headache disorders, and epilepsy as case samples within central nervous system diseases. Extraction of key methodological parameters for sample size calculation was performed independently and peer-reviewed.

Results: In a final sample of seventy-one eligible trials, we collected data from thirty-one trials. Eighteen protocols were obtained from the public domain or principal investigators. Data availability decreased during the extraction process, with almost all data available for stroke-related trials. Of the thirty-one trials with sample size information available, twenty-six reported a predefined calculation and underlying assumptions. Justification was given in twenty and evidence for parameter estimation in sixteen trials. Estimates were most often based on previous research, including RCTs and observational data. Observational data were predominantly represented by retrospective designs. Other references for parameter estimation indicated a lower level of evidence.

Conclusions: Our systematic review of trials on high-risk MDs confirms previous research, which has documented deficiencies regarding data availability and a lack of reporting on sample size calculation. More effort is needed to ensure both relevant sources, that is, original research protocols, to be publicly available and reporting requirements to be standardized.

The Cancer Research Campaign (CRC) Trial demonstrates a decreased incidence of local recurrence for patients randomized to prophylactic radiotherapy following mastectomy. Irradiated patients alive after 5 years, however, have a small increased risk of dying from causes other than breast cancer. How to estimate the cost-benefit of such therapy is discussed.

This article presents a survey of the public and private agencies and institutions providing health care in Israel and examines the degree and nature of the control that these bodies exercise over medical technology. The author demonstrates that while the Israeli government is highly centralized, the Ministry of Health is able to exercise only limited practical influence and is neutralized because of its circumscribed control of government funds. In addition, the Ministry of Health lacks standardized procedures for the assessment of prospective or existing technologies. The author notes that there has been a clear move toward a system to oversee the rational diffusion of technology and outlines several proposals for the future.

Technology assessment in its broadest sense is essential if the highest quality of health care is to be matched to available resources. The results of technology assessment will be meaningful only if they can be transferred in a manner that affects practice as well as policy. Therefore, although we are still far short of an effective system for technology assessment, it is not too early to begin grappling with the problems of transferring the results of such a system when it exists.

In considering future developments in information transfer, it is important to keep several caveats in mind.

This paper examines how the decision-making process and its consequences affect medical technology transfer in major Chinese medical schools. Data are from a 1987 survey of 13 key medical universities, directly supervised by the Ministry of Public Health in the People's Republic of China. This paper limits itself to four types of laboratory equipment — electron microscopes, UV/VIS spectrophotometers, high-performance liquid chromatographs, and polygraphs. Decisions on the transfer of medical technology have been more decentralized in China since the economic reform in 1978. The major reason for schools to import these four types of equipment is their dissatisfaction with the quality of domestic products. Chinese medical schools depend heavily on the information provided at medical equipment exhibits and their neighboring schools. Their decisions to acquire the equipment are based more on the quality and service available than on the prices. Chinese medical schools face serious infrastructure problems in acquiring and maintaining these pieces of equipment. A number of suggestions are made for improving the efficiency of medical technology transfer in China.