[Assessment of medical measures]

Recently, the discipline Health Economics gained considerable interest. This interest was stimulated by the experienced limitations of resources and cost containment which requires the analysis of the values of treatments based on their relative costs and outcomes. The experiences of limited resources could lead to purely cost-based decisions such as favoring inexpensive services instead of facilitating the access to better and more useful ones. In order to decrease the risk of such uneconomic decisions we propose a hierarchy of assessments for the evaluation of clinical services.

This hierarchy is based on the distinction of effectiveness and utility of medical service. Effectiveness is expressed in variable dimensions such as duration of sleep, concentration of blood sugar or diameter of a lesion. Utility is expressed by prolongation of survival and/or improvement of quality of life. The hierarchy suggests to assess the clinical utility from the patient's point of view as a first step by measuring the effects of the service on quantity and quality of life. In a second step, the clinical value of alternative medical interventions from the patient's point of view should be assessed by measuring the patient preference prospectively or the patient compliance retrospectively. Finally, as a third step, the economic value is assessed by comparing costs with outcomes.

The suggested hierarchy should support the selection of the most useful services among alternative measures. In addition it should stimulate cooperation between the involved disciplines.