Ten picture cards, interviews, time logs, and the Klein-Bell ADL scale were useful in assessing the benefits of electrically adjustable beds to patients but not to caregivers. The mean cost per bed per year of US $346 seems, in relation to the benefits, to be a worthwhile investment for increasing patients' quality of life.

This article describes the experience at the Greater Victoria Hospital Society of assessing the appropriateness of introducing laparoscopic cholecystectomy (lap chole) within the framework of an established technology assessment process. Lap chole promised to deliver cost savings; however, these could only be realized by capitalizing on the reduced length of stay by removing the surgical beds from service. A cautionary note is raised as to whether the increased use of lap chole in the population is appropriate.

Magnetic resonance imaging (MRI) is a rapidly evolving medical technology which has become widely diffused before comprehensive assessment of its safety, efficacy, cost-effectiveness, and relative cost-effectiveness compared with diagnostic modalities that it seems most likely to replace could be made. In early 1982 there were fewer than ten units worldwide. In August 1984, there were about 150 units and the figure will be closer to 300 by the end of 1985.

As in all European countries, Germany's public health service expenditures have climbed significantly over the last few years, outstripping increases in GNP and cost of living increases. A detailed analysis of this development shows hospitals to be the sector where costs are escalating the most rapidly.

In spite of major developments in prenatal supervision, perinatal asphyxia remains an important reason for the development of brain damage (18). Epidemiological investigations suggest that perinatal asphyxia actually represents a factor of increasing frequency as a cause of severe cerebral injury (9).

Extracorporeal shock wave lithotripsy (ESWL) for upper urinary stones has been in use in the United States since 1984. It was accepted immediately by hospitals and physicians, and its diffusion has been and continues to be rapid. Government payment and planning policies do not seem to have slowed this diffusion, although they have had some effect on the ownership of lithotripters and the manner in which ESWL is provided. An unintended but foreseeable result of ESWL's popularity with hospitals, physicians, and patients is that ESWL is not only rapidly replacing traditional surgery but is being used on many patients who would not have had surgery. It is likely that many more upper urinary stones are being treated aggressively now than before ESWL was introduced.

In considering the allocation of resources for health it is necessary to make a distinction between the provision of public and environmental health services and the provision of medical care by physicians and surgeons for those patients who seek treatment.

Objectives: The clinical- and cost-effectiveness of tandem mass spectrometry (MS)-based neonatal screening for inborn errors of metabolism (IEM) were evaluated.

We examined staffing levels, acquisition of medical technologies, and utilization of those technologies in private and government teaching hospitals in Japan. Adjusting for size and case mix, we found that government hospitals acquire more technology, use that technology less, and employ a more highly skilled staff than do private hospitals.

This decision-analysis model assesses ambulatory cardiac monitoring (ACM), ACM followed by exercise testing, and electrophysiologic studies (EPS) in the evaluation and selection of antiarrhythmic agents in postinfarct patients with malignant arrhythmias. With existing data, we find no consistent advantage for one method of drug testing over another, although ACM appears to require fewer resources than does EPS. More patients qualify for EPS, but this fact does not increase the proportion of patients for whom a drug can be identified. These methods may test different aspects of arrhythmia activity and drug response, and sequential use may provide additional benefits. Such benefits must be determined empirically.

Healthcare decision makers are increasingly demanding that health technology assessment (HTA) is patient focused, and considers data about patients' perspectives on and experiences with health technologies in their everyday lives. Related data are typically generated through qualitative research, and in HTA the typical approach is to synthesize primary qualitative research through the conduct of qualitative evidence synthesis (QES). Abbreviated HTA timelines often do not allow for the full 6–12 months it may take to complete a QES, which has prompted the Canadian Agency for Drugs and Technologies in Health (CADTH) to explore the concept of “rapid qualitative evidence synthesis” (rQES). In this paper, we describe our experiences conducting three rQES at CADTH, and reflect on challenges faced, successes, and lessons learned. Given limited methodological guidance to guide this work, our aim is to provide insight for researchers who may contemplate rQES. We suggest several lessons, including strategies to iteratively develop research questions and search for eligible studies, use search of filters and limits, and use of a single reviewer experienced in qualitative research throughout the review process. We acknowledge that there is room for debate, though believe rQES is a laudable goal and that it is possible to produce a quality, relevant, and useful product, even under restricted timelines. That said, it is vital to recognize what is lost in the name of rapidity. We intend our paper to advance the necessary debate about when rQES may be appropriate, and not, and enable productive discussions around methodological development.

In the article “Are key principles for improved health technology assessment supported and used by health technology assessment organizations?” by Neumann et al. (3), the authors set out to evaluate the quality of processes used by health technology assessment (HTA) programs based on a set of principles they published in this journal previously (2). We believe that portions of the current article, as they relate to our own organization, are misleading or inaccurate, and welcome this opportunity to correct the inaccuracies.