Journal of General Internal Medicine
Volume 17, Issue 3 pp. 210-220
Free Access

The Limited Incorporation of Economic Analyses in Clinical Practice Guidelines

Joel F. Wallace PharmD, MPH, MBA, 

Joel F. Wallace PharmD, MPH, MBA

Received from Zynx Health Incorporated, a Subsidiary of Cedars-Sinai Health System (JFW, SRW, C-FC, AAH, LSL, JJO), and Cedars-Sinai Departments of Medicine and Health Services Research (SRW, NSH, JJO), Los Angeles, Calif; and TAP Pharmaceutical Products Inc., (JMH, MSR), Lake Forest, Ill.

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Scott R. Weingarten MD, MPH, 

Scott R. Weingarten MD, MPH

Received from Zynx Health Incorporated, a Subsidiary of Cedars-Sinai Health System (JFW, SRW, C-FC, AAH, LSL, JJO), and Cedars-Sinai Departments of Medicine and Health Services Research (SRW, NSH, JJO), Los Angeles, Calif; and TAP Pharmaceutical Products Inc., (JMH, MSR), Lake Forest, Ill.

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Chiun-Fang Chiou PhD, 

Chiun-Fang Chiou PhD

Received from Zynx Health Incorporated, a Subsidiary of Cedars-Sinai Health System (JFW, SRW, C-FC, AAH, LSL, JJO), and Cedars-Sinai Departments of Medicine and Health Services Research (SRW, NSH, JJO), Los Angeles, Calif; and TAP Pharmaceutical Products Inc., (JMH, MSR), Lake Forest, Ill.

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James M. Henning MS, 

James M. Henning MS

Received from Zynx Health Incorporated, a Subsidiary of Cedars-Sinai Health System (JFW, SRW, C-FC, AAH, LSL, JJO), and Cedars-Sinai Departments of Medicine and Health Services Research (SRW, NSH, JJO), Los Angeles, Calif; and TAP Pharmaceutical Products Inc., (JMH, MSR), Lake Forest, Ill.

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Andriana A. Hohlbauch MPH, 

Andriana A. Hohlbauch MPH

Received from Zynx Health Incorporated, a Subsidiary of Cedars-Sinai Health System (JFW, SRW, C-FC, AAH, LSL, JJO), and Cedars-Sinai Departments of Medicine and Health Services Research (SRW, NSH, JJO), Los Angeles, Calif; and TAP Pharmaceutical Products Inc., (JMH, MSR), Lake Forest, Ill.

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Margaret S. Richards PhD, 

Margaret S. Richards PhD

Received from Zynx Health Incorporated, a Subsidiary of Cedars-Sinai Health System (JFW, SRW, C-FC, AAH, LSL, JJO), and Cedars-Sinai Departments of Medicine and Health Services Research (SRW, NSH, JJO), Los Angeles, Calif; and TAP Pharmaceutical Products Inc., (JMH, MSR), Lake Forest, Ill.

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Nicole S. Herzog MD, 

Nicole S. Herzog MD

Received from Zynx Health Incorporated, a Subsidiary of Cedars-Sinai Health System (JFW, SRW, C-FC, AAH, LSL, JJO), and Cedars-Sinai Departments of Medicine and Health Services Research (SRW, NSH, JJO), Los Angeles, Calif; and TAP Pharmaceutical Products Inc., (JMH, MSR), Lake Forest, Ill.

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Lior S. Lewensztain, 

Lior S. Lewensztain

Received from Zynx Health Incorporated, a Subsidiary of Cedars-Sinai Health System (JFW, SRW, C-FC, AAH, LSL, JJO), and Cedars-Sinai Departments of Medicine and Health Services Research (SRW, NSH, JJO), Los Angeles, Calif; and TAP Pharmaceutical Products Inc., (JMH, MSR), Lake Forest, Ill.

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Joshua J. Ofman MD, MSHS, 

Corresponding Author

Joshua J. Ofman MD, MSHS

Address correspondence and requests for reprints to Dr. Ofman: Cedars-Sinai/Zynx Health, 9100 Wilshire Blvd., East Tower, Suite 655, Beverly Hills, CA 90212 (e–mail: [email protected]).Search for more papers by this author
First published: 12 March 2002
https://doi.org/10.1046/j.1525-1497.2002.10522.x
Citations: 1

Abstract

BACKGROUND: Because there is increasing concern that economic data are not used in the clinical guideline development process, our objective was to evaluate the extent to which economic analyses are incorporated in guideline development.

METHODS: We searched medline and HealthSTAR databases to identify English-language clinical practice guidelines (1996–1999) and economic analyses (1990–1998). Additional guidelines were obtained from The National Guidelines Clearinghouse Internet site available at http://www.guideline.gov. Eligible guidelines met the Institute of Medicine definition and addressed a topic included in an economic analysis. Eligible economic analyses assessed interventions addressed in a guideline and predated the guideline by 1 or more years. Economic analyses were defined as incorporated in guideline development if 1) the economic analysis or the results were mentioned in the text or 2) listed as a reference. The quality of economic analyses was assessed using a structured scoring system.

RESULTS: Using guidelines as the unit of analysis, 9 of 35 (26%) incorporated at least 1 economic analysis of above-average quality in the text and 11 of 35 (31%) incorporated at least 1 in the references. Using economic analyses as the unit of analysis, 63 economic analyses of above-average quality had opportunities for incorporation in 198 instances across the 35 guidelines. Economic analyses were incorporated in the text in 13 of 198 instances (7%) and in the references in 18 of 198 instances (9%).

CONCLUSIONS: Rigorous economic analyses may be infrequently incorporated in the development of clinical practice guidelines. A systematic approach to guideline development should be used to ensure the consideration of economic analyses so that recommendations from guidelines may impact both the quality of care and the efficient allocation of resources.

Evidence-based practice guidelines have been advocated as a mechanism for reducing practice variation and improving the quality of care. Systematic approaches to guideline development have been defined and advocated by leading medical journals and authorities. 1–5 Recently, a review of the guideline development process has outlined several deficiencies, including the omission of economic data. 6,7

In an era of increasingly constrained financial resources, allocation of scarce medical resources has become an important factor in health policy decision making. Such policy should rely on the best available evidence as promulgated in evidence-based practice guidelines. 8 Evidence-based medicine and economic analyses address the values of effectiveness and efficiency critical to allocation decision making, 9 and economic analyses are an important type of evidence that could inform the practice of evidence-based medicine. 10 Several sources, including the Consensus Statement on the Role of Cost-Effectiveness Analysis in Health and Medicine, recommend that cost-effectiveness analyses be used as an aid to decision makers 11 and that economic data should be incorporated into guidelines where possible. 12

Because 80% or more of healthcare costs may be directly related to clinical decisions, safely controlling health care costs will require influencing clinical decisions. Guidelines are often used to inform and improve clinical decision making. If guidelines are to address economic issues relevant to clinical decision making, they should be informed by the highest quality economic evaluations available in the published literature. Our objective was to evaluate the extent to which economic analyses are incorporated in the guideline development process.

METHODS

Literature Review and Selection Process

A systematic search of the medline and HealthSTAR computerized bibliographic databases was performed to identify English-language clinical practice guidelines using the MESH heading “Practice Guidelines” for the years 1996–1999. Guidelines were also obtained from The National Guidelines Clearinghouse Internet site ( http://www.guideline.gov).

English-language economic analyses—articles reporting data on direct and indirect costs—were identified through a systematic search of the databases using the MESH headings “Cost-Benefit Analysis” or “Costs and Cost Analysis” for the years 1990–1998. The search time frames for economic analyses and guidelines were chosen such that the economic analyses would likely predate the clinical guidelines. Duplicates, editorials, letters, and reviews were excluded. Then, on the basis of titles, the clinical practice guidelines and economic analyses were grouped by condition within 5 clinical categories: acute therapy, chronic therapy, risk factor reduction, screening, and surgical therapy. These categories were selected in an attempt to include guidelines and economic analyses across a broad spectrum of medical conditions. The medical condition with the greatest number of guidelines and at least 10 economic analyses was selected from each of the 5 categories.

After the 5 conditions were selected, a second literature search was conducted using the same search strategy as before but also including the medical conditions' MESH headings. Four researchers under the supervision of 2 health economists reviewed the identified guidelines and economic analyses and finalized the list for further testing on the basis of several criteria. These 4 researchers included a pharmacist trained in pharmacoeconomics (who was the lead investigator), a physician/health services researcher, a health economist, and an epidemiologist. All 4 researchers had training and experience in health services research methods. Guidelines were eligible for analysis if they: 1) met the Institute of Medicine definition of “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances,”6 2) were described clearly and made recommendations as to appropriate care, 13–15 and 3) addressed a topic included in an economic analysis. Economic analyses were eligible for analysis if they met the following inclusion criteria: 1) assessed interventions specifically addressed in the guideline and 2) predated the guideline publication by 1 or more years. Hand searches of bibliographies of the guidelines that were accepted for analyses further identified additional economic analyses not identified in our search.

Scoring of Economic Analyses

Eligible economic analyses for the 5 conditions were then assessed for methodological quality using a structured scoring system ( Table 1). Since no published checklist or appraisal system enables a quantitative ranking of the quality of economic analyses, we developed a compendium of questions from the most well-known published checklists for evaluating economic studies. 16–20 Items were selected from the existing instruments if they represented a domain present in all existing checklists, and if the item could be operationalized into a yes/no question without changing the content of the item. To ensure content validity, each domain represented in the published checklists was also represented in the final composite instrument. The 4 researchers who finalized the list of guidelines and economic analyses also evaluated the quality of economic analyses with the scoring system. In a pilot test, pairs of reviewers (the lead investigator paired with each of the 3 other reviewers) assessed articles together and resolved the discrepancy among their ratings through several rounds of discussion overseen by the health economist. The agreement between 3 pairs of reviewers was assessed on 3 separate samples of 8 randomly selected economic analyses. The κ values for the samples were 0.87, 0.88, and 0.78. Subsequently, the economic analyses from the 5 conditions were divided among the 4 reviewers, with the lead investigator evaluating articles from 2 conditions. Mean and median scores were calculated for all economic analyses. Analyses scoring higher than the mean were defined as above-average quality.

Table 1. Scoring System for Economic Analyses *
1. Was the study objective clearly defined and measurable? Y / N
2. Was the perspective for the analysis stated clearly? Y / N
3. Was the pharmacoeconomic tool used appropriate for the study? Y / N
4. Was this the tool that was actually used? Y / N
5. Did the study provide a comparison of alternative treatments for patients with the same clinical condition? Y / N
6. Was a complete description of the alternatives given? Y / N
7. Was the evidence of efficacy established through randomized trials? Y / N
8. Was this evidence of efficacy supplemented by evidence of effectiveness applicable to the patient population or subgroups considered in the study? Y / N
9. Were the methods and analysis displayed in a clear and transparent manner? Y / N
10. Were the components of the numerator and denominator displayed? Y / N
11. Were costs and consequences measured in the appropriate physical units? Y / N
12. Were costs and outcomes relevant to the analysis tool chosen? Y / N
13. If the study time was greater than one year, were costs and consequences that occur in the future discounted to their present value? Y / N
14. Equity assumptions made during analysis: if quality-adjusted life years gained by an individual were considered equal, is this acceptable? Y / N
15. Were the results practical for medical decision makers? Y / N
16. Were sensitivity analyses performed by incorporating ranges of values for variables with uncertainty? Y / N
17. Were the assumptions and limitations of the study discussed? Y / N
18. Was an incremental analysis performed? Y / N
19. Were the conclusions of the study justified? Y / N
20. Can the conclusions be generalized to other populations? Y / N
  • *Questions adapted from guidelines for economic evaluation. 16–20

Analysis

Each guideline was then evaluated as to whether eligible economic analyses were incorporated into the eligible guidelines on the basis of the following criteria: 1) the economic analysis or the result of the economic analysis was mentioned in the body of the text, or 2) the economic analysis was listed as a reference. When neither of these criteria was met, the developers of each guideline were then contacted to determine if any economic analyses were incorporated in the guideline development process. Four telephone or e-mail attempts were made to contact the guideline committee/task force chairperson or other members knowledgeable about the guideline development process. A standardized questionnaire was administered to each contact to determine if there were records of additional references used in the development process that could be reviewed for the analysis. If no additional records were available, the contact was asked if there had been any consideration of economic issues by members of the task force. If the contact indicated that there had been such consideration, a list of eligible economic analyses was sent for review. Successful contact (yes/no), consideration of economic issues (yes/no/no recollection), and consideration of eligible economic analyses (yes/no) were documented.

The incorporation of economic analyses in guidelines was evaluated in 2 ways. The first approach used guidelines as the unit of analysis or denominator, and determined the proportion of guidelines that incorporated economic analyses in the text or references. The second approach used economic analyses as the unit of analysis, with a denominator equal to the number of opportunities for economic analyses to be incorporated into guidelines. Economic analyses with opportunities for incorporation were those that met the inclusion criteria described above, i.e., addressing a topic within, and predating, the guideline. Some economic analyses had opportunities for incorporation in more than 1 guideline within each clinical category.

We tested whether there was variation between the conditions studied in the degree to which economic analyses were incorporated into guidelines. Differences between groups were tested using χ2 and Fisher exact tests. Because there may be a time lag between publication of an economic analysis and the incorporation into a guideline, we performed a secondary analysis comparing the rates of incorporation of economic analyses into guidelines for those economic analyses published 1 or more years prior to guideline development and 2 or more years prior to guideline development.

RESULTS

The systematic literature review resulted in 6,722 candidate practice guidelines (356 from the National Guideline Clearinghouse and 6,366 from medline) and 8,096 candidate economic analyses ( Fig. 1). After excluding duplicates, letters, editorials, and reviews and classifying by medical condition on the basis of the title, there were a total of 2,121 candidate practice guidelines and 2,377 candidate economic analyses. The medical conditions with the most candidate practice guidelines and at least 10 candidate economic analyses for each category were acute myocardial infarction, 21–56 asthma, 57–90 smoking cessation, 91–113 colorectal cancer, 114–140 and breast cancer. 141–166 The second literature search with the addition of each condition's MESH heading resulted in the identification of additional guidelines and economic analyses. A total of 180 guidelines and 353 economic analyses were subjected to further review ( Fig. 1).

Details are in the caption following the image
Figure 1
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Results of literature search and grouping process to identify the top medical conditions with the most guidelines and at least 10 economic analyses for each category.

A total of 35 guidelines across the 5 conditions met the inclusion criteria ( Table 2). Hand searches of their bibliographies resulted in 14 additional economic analyses. Among the 367 economic analyses, 112 met the inclusion criteria ( Table 2). Fourteen of these guidelines (40%) were developed by a governmental agency, 11 (31%) were developed by a medical society, 8 (23%) were developed by a nonprofit nonmedical society, and 2 (6%) were published in peer-reviewed medical journals but were not sponsored by an agency. The mean quality score for the 112 eligible economic analyses was 69% (median, 72%). Sixty-three of the 112 eligible economic analyses (56%) had scores greater than 69% and were defined as above-average quality. The distribution of quality scores was similar to that found in previous work. 167

Table 2. Number of Guidelines and Economic Analyses Identified and Included in the Analysis
Category
Acute Therapy Chronic Therapy Risk Factor Reduction Screening Surgical Therapy Total
Condition Myocardial infarction Asthma Smoking cessation Colorectal cancer Breast cancer
Included
 Guidelines, n 6 21–23,28,49,50 5 57–60,63 6 91–93,106,112 6 115–118,130,131 12 141–147,149,153,161,162,164 35
 Economic analyses, n 30 24–27,29–48,51–56 29 61,62,64–90 18 94–105,107–111,113 21 114,119–129,132–140 14 148,150–152,154–160,163,165,166 112
 Economic analyses scoring > mean * 17 13 10 16 7 63
  • * The mean score for all economic analyses is 69% (median, 72%).

Incorporation of Economic Analyses by Guidelines

Using the guidelines as the unit of analysis, the incorporation of economic analyses by guideline is reported across the 5 conditions in Table 3. Eleven of 35 guidelines (31%) incorporated at least 1 eligible economic analysis in the text, and 15 (43%) incorporated at least 1 eligible economic analysis in the references. Nine (26%) of the guidelines incorporated at least 1 economic analysis of above-average quality in the text, and 11 (31%) incorporated at least 1 eligible economic analysis of above-average quality in the references. The 5 conditions were also analyzed individually, revealing statistically significant ( P < .001) variation in the degree to which economic analyses were considered in guideline development ( Table 3). We also evaluated variation when only including economic analyses of above-average quality. The percentage of economic analyses incorporated by guidelines across the 5 conditions ranged from 0 of 12 (0%) for breast cancer to 4 of 6 (67%) in smoking cessation and colorectal cancer and the variation was statistically significant ( P < .005).

Table 3. Incorporation of Economic Analyses by Guidelines
Category
Acute Therapy Chronic Therapy Risk Factor Reduction Screening Surgical Therapy Total
Condition Myocardial infarction Asthma Smoking cessation Colorectal cancer Breast cancer
Any economic analysis
 Guidelines, n 6 5 6 6 12 35
  With economic analyses in text, n (%) 3 (50) 0 (0) 4 (67) 4 (67) 0 (0) 11 (31)
  With economic analyses in references, n (%) 4 (67) 3 (60) 4 (67) 4 (67) 0 (0) 15 (43)
  With economic analyses considered by task force, n (%) 5 (83) 3 (60) 4 (67) 4 (67) 0 (0) 16 (46)
Economic analyses scoring > mean *
 Guidelines, n 6 5 6 6 12 35
  With economic analyses in text, n (%) 1 (17) 0 (0) 4 (67) 4 (67) 0 (0) 9 (26)
  With economic analyses in references, n (%) 2 (33) 1 (20) 4 (67) 4 (67) 0 (0) 11 (31)
  With economic analyses considered by task force, n (%) 3 (50) 1 (20) 4 (67) 4 (67) 0 (0) 12 (34)
  • * The mean score for all economic analyses is 69% (median, 72%).

Of the 20 guidelines failing to incorporate an eligible economic analysis into the body of the text or in the references, 12 of the chairpersons (60%) were successfully interviewed. For 1 of 12 guidelines (8%), the chairperson reported consideration of economic analyses by the task force in guideline development

Incorporation of Economic Analyses by Opportunities for Incorporation

Using the economic analyses as the unit of analysis, the incorporation of economic analyses by opportunities for incorporation is reported across the 5 conditions in Table 4. One hundred twelve eligible economic analyses had an opportunity for incorporation in 300 instances across the 35 guidelines. Economic analyses were incorporated in the body of the text and in the references in 16 of 300 (5%) and 29 of 300 (10%) instances, respectively. Similarly, 63 eligible economic analyses of above-average quality had an opportunity for incorporation in 198 instances across the 35 guidelines. Economic analyses were incorporated in the body of the text and in the references in 13 of 198 (7%) and 18 of 198 (9%) instances, respectively. Twenty-two of the 112 economic analyses (20%) and 16 of the 63 economic analyses of above-average quality (24%) were incorporated into any of the guidelines meeting our inclusion criteria.

Table 4. Economic Analyses Guidelines by Opportunities for Incorporation
Category
Acute Therapy Chronic Therapy Risk Factor Reduction Screening Surgical Therapy Total
Condition Myocardial infarction Asthma Smoking cessation Colorectal cancer Breast cancer
Economic analyses
 Opportunities for economic analyses to be incorporated in guidelines, n 94 35 36 92 43 300
  Economic analyses incorporated in text, n (%) 4 (4) 0 (0) 4 (11) 8 (9) 0 (0) 16 (5)
  Economic analyses incorporated in references, n (%) 9 (10) 3 (9) 7 (19) 10 (11) 0 (0) 29 (10)
Economic analyses scoring >mean *
 Opportunities for economic analyses to be incorporated in guidelines, n 61 18 25 68 26 198
  Economic analyses incorporated in text, n (%) 2 (3) 0 (0) 4 (16) 7 (10) 0 (0) 13 (7)
  Economic analyses incorporated in references, n (%) 3 (5) 1 (6) 6 (24) 8 (12) 0 (0) 18 (9)
  • * The mean score for economic analyses is 69% (median, 72%).

As shown in Table 4, risk reduction guidelines (as represented by smoking cessation) had the highest percentage of economic analyses incorporated (i.e., 19%). Eighteen economic analyses had opportunities for incorporation in 36 instances across the 6 risk reduction guidelines. Economic analyses were incorporated in the text and in the references in 4 of 36 (11%) and 7 of 36 (19%) instances, respectively. Smoking cessation also had the highest percentage of analyses of above-average quality incorporated. Ten analyses of above-average quality had opportunities for incorporation in 25 instances across the 6 smoking cessation guidelines. Economic analyses were incorporated in the text and in the references in 4 of 25 (16%) and 6 of 25 (24%) instances, respectively.

Analysis by Number of Years Between Publication of Economic Analysis and Guideline

We also compared the rates of incorporation of economic analyses into guidelines for economic analyses published 1 or more years prior to guideline development with those published 2 or more years prior to guideline development. There were no significant differences between economic analyses published 1 or more years prior to guideline development and those published 2 or more years prior to guideline development for incorporation in the body of guideline (5.3% vs 4.6%; P = .69) or in the references (9.6% vs 10.5%; P = .76).

COMMENT

Economic analyses appear to be infrequently incorporated in the development of clinical practice guidelines. Twenty of the 35 guidelines (57%) failed to incorporate any eligible economic analysis into the text or in the references. Ninety of the 112 economic analyses (80%) failed to be incorporated into any of the guidelines meeting our inclusion criteria. These findings are inconsistent with recommendations that economic analyses should be taken into account when developing guidelines.

The paucity of high-quality economic data within the clinical guideline development process makes it increasingly difficult for decision makers to allocate limited health care resources efficiently. It is unlikely that this is due to the lack of higher quality, published economic analyses, based on the number identified in this study. Certain clinical conditions were more likely to incorporate economic analyses than others. Conditions amenable to risk factor reduction or preventative care, such as smoking cessation and colorectal cancer screening, were more likely to incorporate economic analyses than, for example, surgical therapy for breast cancer. This suggests there may be greater rationale to justify program benefits economically when the benefits will occur in the future compared to treatments with more immediate impact.

There are some limitations to this analysis. We attempted, a priori, to stratify our analysis by the quality of the economic analysis because we do not believe that guidelines should incorporate the results of economic analyses that do not meet standards for reporting and methodological rigor. Because we were unable to identify a valid scoring system for quality, 167 we developed one from existing instruments. 1–20 This composite system assumes that each item carries equal weight, and it has not been formally validated. While construct validity was not tested in this study, we believe that the composite instrument has face, or content, validity since each domain from existing checklists is represented and the distribution of quality scores obtained with this instrument appears similar to the distributions found in other studies using different methods. Moreover, there was high inter-rater agreement, suggesting adequate reliability. A limitation of our composite instrument is that items that are relevant to only specific types of economic analyses may be lacking, such as a specific item about utility values. Further study of the construct and discriminant validity of the composite scoring system appears warranted. One reason for the lack of incorporation of economic analyses in guidelines may be that there is no standardized method for developers of guidelines to determine which economic analyses merit incorporation on the basis of their quality.

Another limitation of our analysis is that we did not grade the quality of the practice guidelines. While appraisal systems exist to identify certain elements that guidelines should include, there is no acceptable system for ranking or comparing the relative quality of clinical practice guidelines. In light of this, a priori we assumed that if economic analyses were considered in the guideline development process, consideration would most likely occur in high-profile guidelines developed by national societies and published in the peer-reviewed literature.

A third limitation is that we used a very specific (MESH headings) rather than sensitive (keywords) search strategy, recognizing that we wanted a “sample” of the universe of published economic analyses and guidelines. Thus, our sample may not be completely representative of all relevant articles. Moreover, because this analysis included only guidelines published in peer-reviewed journals or on the National Guidelines Clearinghouse website, it may be susceptible to publication bias.

Furthermore, although we attempted to analyze a representative sample of published guidelines, we nonetheless submitted a sample of 5 conditions to evaluation. Since we only examined 1 condition in each category, all of the analyses performed in the current study were based on relatively small samples. This may influence the generalizability of the findings. However, the conditions chosen were those with the greatest number of clinical guidelines and at least 10 published economic analyses predating the guidelines. We also recognized that the recollection of the guideline committee regarding the consideration of economic analyses by the group might not be completely reliable. Nevertheless, we felt that this was the only available method for obtaining information regarding whether the group developing the guideline did not consider any economic analyses or simply could not identify any economic analyses.

Finally, it may be considered unlikely that economic analyses published only 1 year prior to guideline development would be incorporated into a practice guideline. We explored this by comparing the rates of incorporation of economic analyses into guidelines for economic analyses published 1 or more years prior to guideline development and 2 or more years prior to guideline development. When we limited our analysis to only economic analyses published 2 or more years prior to guideline development, the results were unchanged.

In an era of increasing scrutiny of the costs and benefits of medical interventions, clinical practice guidelines are needed to inform practitioners about the most effective and efficient management strategies. Because there is a proliferation of economic evaluations and methodological standards for these evaluations in the literature, economic findings should be incorporated in the guideline development process. However, incorporating economic analyses of poor quality in the guideline could potentially decrease the value of the guideline and mislead the users. Therefore, practical standardized methods for assessing the quality of economic analyses appear to be needed. We are concerned that guidelines and ensuing policy recommendations may not be informed by economic evaluations that elucidate and promote the most efficient utilization of health care resources. Further research is necessary to identify barriers to the incorporation of economic analyses in the guideline development process.

This investigator-initiated work was supported by a research grant from TAP Pharmaceutical Products, Inc.

Appendix

A ppendix B: R eferences I dentified I n“G uideline” S earch, B ut N ot I ncluded I n T he P resent A nalysis

  • 1

    Executive summary of disease management of drug hypersensitivity: a practice parameter. Joint Task Force on Practice Parameters, the American Academy of Allergy, Asthma and Immunology, the American Academy of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol 1999; 83(6 Pt 3):665–700.

  • 2

    Position statement on the administration of immunotherapy outside of the prescribing allergist facility.Drugs and Anaphylaxis Committee of the American College of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol 1998; 81(2):101–102.

  • 3

    CCMRC/GINA. Workshop on asthma management and prevention in the Caribbean. July 1–3, 1997, Trinidad. Commonwealth Caribbean Medical Research Council. Global Initiative for Asthma. West Indian Med J 1998; 47(4):133–152.

  • 4

    Position statement. Environmental allergen avoidance in allergic asthma. Ad Hoc Working Group on Environmental Allergens and Asthma. J Allergy Clin Immunol 1999; 103(2 Pt 1):203–205.

  • 5

    Health care guideline: asthma in children. In: Institute for Clinical Systems Integration 1996; 1996 health care guidelines, Volume 2:Bloomington-32.

  • 6

    Health care guideline: diagnosis and management of asthma in adults. In: Institute for Clinical Systems Integration 1996; 1996 health care guidelines, Volume 2:Bloomington-74.

  • 7

    Idiopathic environmental intolerances. American Academy of Allergy, Asthma and Immunology (AAAAI) Board of Directors. J Allergy Clin Immunol 1999; 103(1 Pt 1):36–40.

  • 8

    North of England evidence based guidelines development project: summary version of evidence based guideline for the primary care management in adults. North of England Asthma Guideline Development Group. BMJ 1996; 312(7033):762–766.

  • 9

    Safety and appropriate use of salmeterol in the treatment of asthma. AAAAI Committee on Drugs, American Academy of Allergy, Asthma and Immunology. J Allergy Clin Immunol 1996; 98(3):475–480.

  • 10

    Practice parameters for allergen immunotherapy. Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology. J Allergy Cln Immunol 1996; 98 (6 Pt 1):1001–1011.

  • 11

    Specific allergen immunotherapy for asthma. A position paper of the Thoracic Society of Australia and New Zealand and the Australasian Society of Clinical Immunology and Allergy. Med J Aust 1997; 167(10):540–544.

  • 12

    Asthma in children under five years of age. The General Practitioner in Asthma Group, the British Association of Accident and Emergency Medicine, the British Paediatric Respiratory Society and the Royal College of Paediatrics and Child Health. Thorax 1997; 52 Suppl 1:S9–21.

  • 13

    Nebulizer therapy. Guidelines. British Thoracic Society Nebulizer Project Group. Thorax 1997; 52 Suppl 2:S4–24.

  • 14

    The use of standardized allergen extracts. American Academy of Allergy, Asthma and Immunology (AAAAI). J Allergy Clin Immunol 1997; 99(5):583–586.

  • 15

    Practice guideline for the treatment of patients with nicotine dependence. American Psychiatric Association. Am J Psychiatry 1996; 153(10 Suppl):1–31.

  • 16

    Smoking cessation: AHCPR spells out strategies that work. Healthcare Demand & Disease Management 1997; 3(8):118–119.

  • 17

    American Thoracic Society issues a new position statement on smoking and health. American Family Physician 1996; 54(1):365–366.

  • 18

    New guidelines for smoking cessation. Mississippi RN 1996; 58 (4):18.

  • 19

    From the Centers for Disease Control and Prevention. Screening for colorectal cancer—United States, 1992-1993, and new guidelines. JAMA 1996; 275(11):830–831.

  • 20

    Clinical practice guidelines for the use of tumor markers in breast and colorectal cancer. Adopted on May 17, 1996 by the American Society of Clinical Oncology. J Clin Oncol 1996; 14(10):2843–2877.

  • 21

    Maturing Colorado collective tackles measurement, financial challenges. Quality Letter for Healthcare Leaders 1999; 11(2):17–19.

  • 22

    AHCPR releases evidence report on colorectal cancer screening. Oncology 1997; 11(3):342–344.

  • 23

    AAFP recommends seven action steps for family physicians in the battle against tobacco. Am Fam Physician 1996; 53(2):776.

  • 24

    North of England evidence based guidelines development project: summary version of evidence based guideline for the primary care management angina. North of England Stable Angina Guideline Development Group. BMJ 1996; 312(7034):827–832.

  • 25

    Smoking cessation: information for specialists. Smoking Cessation Guideline Panel. Agency for Health Care Policy and Research. Am Fam Physician 1996; 53(8):2599–8.

  • 26

    Smoking cessation: information for specialists. AHCPR. Dermatol Nurs 1997; 9(1):51–56.

  • 27

    Quick reference guide for clinicians. Smoking cessation: information for specialists. U.S. Department of Health and Human Services. Journal of the American Academy of Nurse Practitioners 1996; 8(7):317–322.

  • 28

    ASHP therapeutic position statement on smoking cessation. American Society of Health-System Pharmacists. Am J Health Syst Pharm 1999; 56(5):460–464.

  • 29

    Guidelines for the management of chronic obstructive pulmonary disease. Working Group of the South African Pulmonology Society. S Afr Med J 1998; 88(8):999–10.

  • 30

    New process results in dramatic improvement for heart attack patients, lower hospital costs. Health Care Cost Reengineering Rep 1999; 4(2):20–24.

  • 31

    Improve AMI (acute myocardial infarction) therapy by working with ICU, ED. Hosp Case Manag 1996; 4(11):172–175.

  • 32

    Albrecht S, Cassidy B, Reynolds MD, Ketchem S, Abriola D. Developing guidelines for smoking cessation interventions for pregnant adolescents. Journal of Pediatric Nursing 1999; 14 (3):150–156.

  • 33

    Angelini P. Guidelines for surgical standby for coronary angioplasty: should they be changed? J Am Coll Cardiol 1999; 33(5):1266–1268.

  • 34

    Appleton MA, Douglas-Jones AG, Morgan JM. Evidence of effectiveness of clinical audit in improving histopathology reporting standards of mastectomy specimens. Journal of Clinical Pathology 1998; 51(1):30–33.

  • 35

    Badano L, Cassin M, Solinas L, Burelli C, Macor F, Zanuttini D. Clinical impact of local implementation of agreed guidelines for the management of patients with acute myocardial infarction. G Ital Cardiol 1999; 29(1):39–47.

  • 36

    Barold SS. American College of Cardiology/American Heart Association guidelines for pacemaker implantation after acute myocardial infarction. What is persistent advanced block at the atrioventricular node? Am J Cardiol 1997; 80(6):770–774.

  • 37

    Barron HV, Rundle A, Gurwitz J, Tiefenbrunn A. Reperfusion therapy for acute myocardial infarction: observations from the National Registry of Myocardial Infarction 2. Cardiol Rev 1999; 7(3):156–160.

  • 38

    Becker RC. New thrombolytics, anticoagulants, and platelet antagonists: the future of clinical practice. J Thromb Thrombolysis 1999; 7(2):195–220.

  • 39

    Bernstein LH. Practice guideline for cardiac profiling. Am J Clin Pathol 1997; 108(6):695–696.

  • 40

    Birbari AE. Calcium channel antagonists revisited. J Med Liban 1996; 44(2):59.

  • 41

    Blichert-Toft M, Smola MG, Cataliotti L, O'Higgins N. Principles and guidelines for surgeons—management of symptomatic breast cancer. European Society of Surgical Oncology. Eur J Surg Oncol 1997; 23(2):101–109.

  • 42

    Boerner S, Fornage BD, Singletary E, Sneige N. Ultrasound-guided fine-needle aspiration (FNA) of nonpalpable breast lesions: a review of 1885 FNA cases using the National Cancer Institute-supported recommendations on the uniform approach to breast FNA. Cancer 1999; 87(1):19–24.

  • 43

    Bond JH. Screening guidelines for colorectal cancer. American Journal of Medicine 1999; 106(1A):7S–10S.

  • 44

    Bousquet J, Lockey R, Malling HJ, Alvarez-Cuesta E, Canonica GW, Chapman MD et al. Allergen immunotherapy: therapeutic vaccines for allergic diseases. World Health Organization. American academy of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol 1998; 81(5 Pt 1):401–405.

  • 45

    Bowles KE, Wynne C, Baime MJ. Screening for cancer in the patient with rheumatic disease. Rheumatic Diseases Clinics of North America 1999; 25(3):719–744.

  • 46

    Bradshaw C, Parr JH, Eccles MP, Whitty P, Murray E, Broderick W et al. Aspirin in acute myocardial infarction. Br J Gen Pract 1996; 46(405):255.

  • 47

    Brouwers MC, Browman GP. Development of clinical practice guidelines: surgical perspective. World J Surg 1999; 23(12):1236–1241.

  • 48

    Burke CA, Van Stolk R. Colorectal cancer screening: making sense of the different guidelines. Cleveland Clinic Journal of Medicine 1999; 66(5):303–311.

  • 49

    Campbell S. New AHCPR guideline targets and cost of smoking cessation programs. Health Care Strategic Management 1996; 14(6):16–17.

  • 50

    Canavan K. ANA endorses guidelines for smoking cessation, urinary incontinence. American Nurse 1996; 28(5):8.

  • 51

    Cannon CP. Advances in the medical management of acute coronary syndromes. J Thromb Thrombolysis 1999; 7(2):171–189.

  • 52

    Carney PA, Eliassen MS, Wells WA, Swartz WG. Can we improve breast pathology reporting practices? A community-based breast pathology quality improvement program in New Hampshire. J Community Health 1998; 23(2):85–98.

  • 53

    Carrick SE, Bonevski B, Redman S, Simpson J, Sanson-Fisher RW, Webster F. Surgeons' opinions about the NHMRC clinical practice guidelines for the management of early breast cancer. Med J Aust 1998; 169(6):300–305.

  • 54

    Cerrato PL. New acute MI guidelines. RN 1997; 60(1):25–26.

  • 55

    Cheung KL. Management of primary breast cancer in Hong Kong—can the guidelines be met? Eur J Surg Oncol 1999; 25(3):255–260.

  • 56

    Christenson RH, Duh SH. Evidence based approach to practice guides and decision thresholds for cardiac markers. Scand J Clin Lab Invest Suppl 1999; 230:90–102.

  • 57

    Christiaens MR, van der Schueren E, Vantongelen K. More detailed documentation of operative procedures in breast conserving treatment: what good will it do us? European Journal of Surgical Oncology 1996; 22(4):326–330.

  • 58

    Cisek J, Ornato JP. Intravenous beta blockade in acute myocardial infarction. Am J Emerg Med 1998; 16(7):720–721.

  • 59

    Clarke E, Hemlock A, Norwell N. A patient with a complaint against a practice partner. Practitioner 1999; 243(1599):443–452.

  • 60

    Clough JB. Recommendations for peak flow monitoring in children. British Thoracic Society. Respir Med 1996; 90(8):459–461.

  • 61

    Cressy DS, DeBoisblanc BP. Diagnosis and management of asthma: a summary of the National Asthma Education and Prevention Program guidelines. National Institutes of Health. J La State Med Soc 1998; 150(12):611–617.

  • 62

    Cromwell J, Bartosch WJ, Fiore MC, Hasselblad V, Baker T. Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline for smoking cessation. Agency for Health Care Policy and Research. JAMA 1997; 278(21):1759–1766.

  • 63

    Curry SJ. Building effective strategies to decrease tobacco use in a health maintenance organisation: Group Health Cooperative of Puget Sound. Tobacco Control 1998; 7 Suppl:S21–3discussion.

  • 64

    Daher M. Consensus conference. Colorectal cancer: prevention, screening and management. Journal Medical Libanais - Lebanese Medical Journal 1998; 46(5):268–279.

  • 65

    DeWeese J. Best practices for smoking cessation intervention for hospitalized patients. Indiana Medicine 1996; 89(2):181–183.

  • 66

    Durham SR. Allergen avoidance measures. British Thoracic Society. Respiratory Medicine 1996; 90(8):441–445.

  • 67

    Edge SB. Breast cancer practice guidelines: evaluation and quality improvement. Oncology (Huntingt) 1997; 11(11A):151–154.

  • 68

    Edhouse JA, Sakr M, Angus J, Morris FP. Suspected myocardial infarction and left bundle branch block: electrocardiographic indicators of acute ischaemia. J Accid Emerg Med 1999; 16(5):331–335.

  • 69

    Edhouse JA, Sakr M, Wardrope J, Morris FP. Thrombolysis in acute myocardial infarction: the safety and efficiency of treatment in the accident and emergency department. J Accid Emerg Med 1999; 16(5):325–330.

  • 70

    Eisinger F, Geller G, Burke W, Holtzman NA. Cultural basis for differences between US and French clinical recommendations for women at increased risk of breast and ovarian cancer. Lancet 1999; 353(9156):919–920.

  • 71

    Farnsworth AE. Surgical standby for coronary interventions. Aust N Z J Med 1998; 28(2):153–154.

  • 72

    Fiore MC. Overview of the Agency for Health Care Policy and Research guideline. Tobacco Control 1998; 7 Suppl:S14–6discussion.

  • 73

    Fiore MC, Jorenby DE, Baker TB. Smoking cessation: principles and practice based upon the AHCPR Guideline, 1996. Agency for Health Care Policy and Research. Ann Behav Med 1997; 19(3):213–219.

  • 74

    Fiore MC. AHCPR smoking cessation guideline: a fundamental review. Tob Control 1997; 6 Suppl 1:S4–S8.

  • 75

    Georgitis JW. The 1997 Asthma Management Guidelines and therapeutic issues relating to the treatment of asthma. National Heart, Lung, and Blood Institute. Chest 1999; 115(1):210–217.

  • 76

    Gibbons RJ, Balady GJ, Beasley JW, Bricker JT, Duvernoy WF, Froelicher VF et al. ACC/AHA Guidelines for Exercise Testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol 1997; 30(1):260–311.

  • 77

    Gibler WB. Chest pain units: do they make sense now? Ann Emerg Med 1997; 29(1):168–171.

  • 78

    Golden WE, Sanchez N. The cooperative cardiovascular project an AFMC special report. J Ark Med Soc 1996; 92(12):617–619.

  • 79

    Golden WE, Sanchez N. The cooperative cardiovascular project an AFMC special report. Journal of the Arkansas Medical Society 1996; 92(12):617–619.

  • 80

    Goldsmith MF. Revised guidelines for managing acute MI. JAMA 1997; 277(3):200.

  • 81

    Goldstein MG. Bupropion sustained release and smoking cessation. Journal of Clinical Psychiatry 1998; 59 Suppl 4:66–72.

  • 82

    Goldstein MG, DePue JD, Monroe AD, Lessne CW, Rakowski W, Prokhorov A et al. A population-based survey of physician smoking cessation counseling practices. Preventive Medicine 1998; 27(5 Pt 1):720–729.

  • 83

    Gottlieb SS. Time to practice what we preach: the use of beta-blockers post myocardial infarcation. Eur Heart J 1999; 20(10):701–702.

  • 84

    Hebert-Croteau N, Brisson J, Latreille J, Blanchette C, Deschenes L. Variations in the treatment of early-stage breast cancer in Quebec between 1988 and 1994. CMAJ 1999; 161(8):951–955.

  • 85

    Helmlinger CS. Nurses play key role in war on tobacco: new guideline supports nurses' consumer education efforts. American Nurse 1996; 28(4):12.

  • 86

    Heriot AG, Murday V, Kumar D. Screening relatives of patients with colorectal cancer: the need for continuing education. Journal of the Royal College of Surgeons of Edinburgh 1999; 44(1):13–15.

  • 87

    Hislop TG, Olivotto IA, Coldman AJ, Trevisan CH, Kula J, McGregor GI et al. Variations in breast conservation surgery for women with axillary lymph node negative breast cancer in British Columbia. Can J Public Health 1996; 87(6):390–394.

  • 88

    Hood S, Birnie D, Curzio JL, Hillis WS. Wide variation in the use of thrombolytic therapy among junior doctors in south and central Scotland. Health Bull (Edinb) 1996; 54(2):131–139.

  • 89

    Hughes JR, Goldstein MG, Hurt RD, Shiffman S. Recent advances in the pharmacotherapy of smoking. JAMA 1999; 281(1):72–76.

  • 90

    Hughes JR. Taking smoking cessation treatment seriously: the American Psychiatric Association's Practice Guideline for the Treatment of Patients with Nicotine Dependence. Addiction 1998; 93(4):469–470.

  • 91

    Ishikawa K. Antiplatelet agents prevent cardiac events in patients with coronary artery disease. Intern Med 1998; 37 (2):199–202.

  • 92

    Jesse RL, Kontos MC. Evaluation of chest pain in the emergency department. Curr Probl Cardiol 1997; 22(4):149–236.

  • 93

    Johnson BA. Flexible sigmoidoscopy: screening for colorectal cancer. American Family Physician 1999; 59(2):313–324.

  • 94

    Johnson BA. Flexible sigmoidoscopy: screening for colorectal cancer [corrected and republished article originally printed in Am Fam Physician 1999 Jan 15;59(2):313–24, 327–8]. American Family Physician 1999; 59(6):1537–1546.

  • 95

    Jorenby DE, Fiore MC. The Agency for Health Care Policy and Research smoking cessation clinical practice guideline: basics and beyond. Prim Care 1999; 26(3):513–528.

  • 96

    Jorenby DE, Fiore MC, Smith SS, Baker TB. Treating cigarette smoking with smokeless tobacco: a flawed recommendation. American Journal of Medicine 1998; 104(5):499–500.

  • 97

    Karpas CM, White RM, Sr. Practice guideline for cardiac profiling. Am J Clin Pathol 1997; 108(6):696–699.

  • 98

    Kennedy M. Smoke-free signals from the chief: new federal regulations and clinical practice guideline help physicians help reduce tobacco use. Wisconsin Medical Journal 1996; 95(11):762–766.

  • 99

    Kizer JR, Cannon CP, McCabe CH, Mueller HS, Schweiger MJ, Davis VG et al. Trends in the use of pharmacotherapies for acute myocardial infarction among physicians who design and/or implement randomized trials versus physicians in routine clinical practice: the MILIS-TIMI experience. Multicenter Investigation on Limitation of Infarct Size. Thrombolysis in Myocardial Infarction. Am Heart J 1999; 137(1):79–92.

  • 100

    Krug P. Breast cancer legislation active in several states. AORN Journal 1997; 66(2):330–333.

  • 101

    Kuntz KM, Tsevat J, Weinstein MC, Goldman L. Expert panel vs decision-analysis recommendations for postdischarge coronary angiography after myocardial infarction. JAMA 1999; 282(23):2246–2251.

  • 102

    Kupecz DB. Trends in smoking cessation. Colorado Nurse 1996; 96(4):25.

  • 103

    Landrum MB, McNeil BJ, Silva L, Normand SL. Understanding variability in physician ratings of the appropriateness of coronary angiography after acute myocardial infarction. J Clin Epidemiol 1999; 52(4):309–319.

  • 104

    Lescoe-Long M, Long MJ. Defining the utility of clinically acceptable variations in evidence- based practice guidelines for evaluation of quality improvement activities. Eval Health Prof 1999; 22(3):298–324.

  • 105

    Letovsky E, Allen T. Initiating thrombolytic therapy for acute myocardial infarction: whose job is it anyway? CMAJ 1996; 154(4):509–511.

  • 106

    Luskin AT. An overview of the recommendations of the Working Group on Asthma and Pregnancy. National Asthma Education and Prevention Program. J Allergy Clin Immunol 1999; 103(2 Pt 2):S350–S353.

  • 107

    MacKenzie TD. New strategies for smoking cessation. Hospital Practice (Office Edition) 1999; 34(Office Edition):25–26.

  • 108

    Maggioni AP, Latini R. How to use ACE-inhibitors, beta-blockers, and newer therapies in AMI. Am Heart J 1999; 138(2 Pt 2):183–187.

  • 109

    McCarthy DO, Blamey RW, Robertson JF, Mitchell AK. A one-year audit of 255 operable breast cancers. European Journal of Surgical Oncology 1997; 23(5):399–402.

  • 110

    McDonald CF, Burdon JG. Asthma in pregnancy and lactation. A position paper for the Thoracic Society of Australia and New Zealand. Med J Aust 1996; 165(9):485–488.

  • 111

    McLaughlin T. Success in translating guidelines for beta-blocker use in patients following acute myocardial infarction into improved clinical care. Am J Med 1999; 106(5):594–595.

  • 112

    McLaughlin TJ, Soumerai SB, Willison DJ, Gurwitz JH, Gao X, Borbas C et al. The effect of comorbidity on use of thrombolysis or aspirin in patients with acute myocardial infarction eligible for treatment. J Gen Intern Med 1997; 12(1):1–6.

  • 113

    Miner TJ, Shriver CD, Flicek PR, Miner FC, Jaques DP, Maniscalco-Theberge ME et al. Guidelines for the safe use of radioactive materials during localization and resection of the sentinel lymph node. Ann Surg Oncol 1999; 6(1):75–82.

  • 114

    Norris RM. Guidelines on managing stable angina omit important point. BMJ 1996; 312(7047):1675.

  • 115

    Parrott S, Godfrey C, Raw M, West R, McNeill A. Guidance for commissioners on the cost effectiveness of smoking cessation interventions. Health Educational Authority. Thorax 1998; 53 Suppl 5 Pt 2:S1–38.

  • 116

    Paterson IC. A detailed baseline audit of radiotherapy for primary breast cancer: old habits, new principles. Clinical Oncology (Royal College of Radiologists) 1998; 10(Royal College of Radiologists):95–102.

  • 117

    Percival J. Going up in smoke. Nursing Standard 1999; 13(25):16–17.

  • 118

    Pesce AJ, Rashkin M, Kotagal U. Standards of laboratory practice: theophylline and caffeine monitoring. National Academy of Clinical Biochemistry. Clin Chem 1998; 44(5):1124–1128.

  • 119

    Peterson ED, Shaw LJ, Califf RM. Clinical Guidleine: Part II: Risk Stratification after Myocardial Infarction. Annals of Internal Medicine 1997; 126 (7):561–582.

  • 120

    Pierce CH. Asthma therapy from the practice perspective: changes in the wind. Journal of Clinical Pharmacology 1999; 39(3):223–229.

  • 121

    Plebani M, Zaninotto M. Cardiac markers: present and future. Int J Clin Lab Res 1999; 29(2):56–63.

  • 122

    Quanjer PH, Lebowitz MD, Gregg I, Miller MR, Pedersen OF. Peak expiratory flow: conclusions and recommendations of a Working Party of the European Respiratory Society. European Respiratory Journal - Supplement 1997; 24:2S–8S.

  • 123

    Raw M, McNeill A, West R. Smoking cessation: evidence based recommendations for the healthcare system. BMJ 1999; 318(7177):182–185.

  • 124

    Rex DK. American Cancer Society guidelines—are we truly improving all aspects of effectiveness? American Journal of Gastroenterology 1998; 93(3):475–477.

  • 125

    Roski J. Changing practice patterns as a result of implementing the Agency for Health Care Policy and Research guideline in 20 primary care clinics. Tobacco Control 1998; 7 Suppl:S19–20discussion.

  • 126

    Rothenberger D. The American Cancer Society guidelines for colorectal cancer screening: have we gone too far (or not far enough)? Gastroenterology 1998; 114(6):1341–1343.

  • 127

    Sarasin FP, Maschiangelo ML, Schaller MD, Heliot C, Mischler S, Gaspoz JM. Successful implementation of guidelines for encouraging the use of beta blockers in patients after acute myocardial infarction. Am J Med 1999; 106(5):499–505.

  • 128

    Schiff I, Bell WR, Davis V, Kessler CM, Meyers C, Nakajima S et al. Oral contraceptives and smoking, current considerations: recommendations of a consensus panel. American Journal of Obstetrics & Gynecology 1999; 180(6 Pt 2):S383–S384.

  • 129

    Simoons ML, Boersma E, Maas AC, Deckers JW. Management of myocardial infarction: the proper priorities. Eur Heart J 1997; 18(6):896–899.

  • 130

    Skaar K, Tsoh J, Cinciripini P, Wetter D, Prokhorov A, Gritz E. Current approaches in smoking cessation. Current Opinion in Oncology 1996; 8(5):434–440.

  • 131

    Sladden MJ, Ward JE. Australian general practitioners' views and use of colorectal cancer screening tests. Medical Journal of Australia 1999; 170(3):110–113.

  • 132

    Smith SC, Jr. ACE inhibitor therapy: benefits and underuse. Am Fam Physician 1999; 59(1):35–6, 38.

  • 133

    Soumerai SB, McLaughlin TJ, Gurwitz JH, Guadagnoli E, Hauptman PJ, Borbas C et al. Effect of local medical opinion leaders on quality of care for acute myocardial infarction: a randomized controlled trial. JAMA 1998; 279(17):1358–1363.

  • 134

    Stark ME, Crowe JPJ. Breast cancer evaluation and follow-up: a survey of The Ohio Chapter of The American College of Surgeons. Am Surg 1996; 62(6):458–460.

  • 135

    Summers RL, Tisdale B, Kolb JC, Woodward LA. Role of technetium-99m sestamibi myocardial imaging in the emergency department evaluation of chest pain. J Miss State Med Assoc 1998; 39(5):176–179.

  • 136

    Tarlo SM, Boulet LP, Cartier A, Cockcroft D, Cote J, Hargreave FE et al. Canadian Thoracic Society guidelines for occupational asthma. Can Respir J 1998; 5(4):289–300.

  • 137

    Tietz NW. Practice guideline for cardiac profiling. Am J Clin Pathol 1997; 108(6):696–699.

  • 138

    Tompkins NO, Dino GA, Zedosky LK, Harman M, Shaler G. A collaborative partnership to enhance school-based tobacco control policies in West Virginia. Center for Disease Control and Prevention. Am J Prev Med 1999; 16(3 Suppl):29–34.

  • 139

    Tropman SE, Ricketts TC, Paskett E, Hatzell TA, Cooper MR, Aldrich T. Rural breast cancer treatment: evidence from the Reaching Communities for Cancer Care (REACH) project. Breast Cancer Research & Treatment 1999; 56(1):59–66.

  • 140

    Verani MS. Risk stratifying patients who survive an acute myocardial infarction. J Nucl Cardiol 1998; 5(1):96–108.

  • 141

    Ward S. Addressing nicotine addiction in women. Role of the midwife. Journal of Nurse-Midwifery 1999; 44(1):3–18.

  • 142

    Wewers ME, Ahijevych KL, Sarna L. Smoking cessation interventions in nursing practice. Nursing Clinics of North America 1998; 33(1):61–74.

  • 143

    Whelan TJ, Lada BM, Laukkanen E, Perera FE, Shelley WE, Levine MN. Breast irradiation in women with early stage invasive breast cancer following breast conservation surgery. Provincial Breast Disease Site Group. Cancer Prev Control 1997; 1(3):228–240.

  • 144

    Williams C. Dissemination of the Agency for Health Care Policy and Research guideline. Tobacco Control 1998; 7 Suppl:S17–8discussion.

  • 145

    Williams WL. Guidelines to reducing delays in administration of thrombolytic therapy in acute myocardial infarction. Drugs 1998; 55(5):689–698.

APENDIX II: References identified in “Economic Analysis” Search, but NOT included in the present analysis

  • 1

    Prevention of hypertension and associated cardiovascular disease. A 1995 statement. Conclusions from a joint WHO/ISH Meeting. Clinical & Experimental Hypertension (New York) 1996; 18(New York):581–593.

  • 2

    From the Centers for Disease Control. Public health focus: effectiveness of smoking-control strategies—United States. JAMA 1992; 268(13):1645–1646.

  • 3

    Getting employees to say no … to smoking. Bus Health 1993; 11 (3):42–4, 46.

  • 4

    Public health focus: effectiveness of smoking-control strategies—United States. MMWR - Morbidity & Mortality Weekly Report 1992; 41(35):645–647.

  • 5

    Asthma: the role of fluticasone propionate. Br J Hosp Med 1998; 58(11):555–564.

  • 6

    Control of hereditary diseases. Report of a WHO Scientific Group. World Health Organ Tech Rep Ser 1996; 865:1–84.

  • 7

    Disease management programs: benchmarking costs, savings, ROI. Healthcare Benchmarks 1998; 5(8):117–119.

  • 8

    Path inventory facilitates benchmarking care paths. Healthcare Benchmarks 1997; 4(11):159–161.

  • 9

    Abdul-Mohsen MF, al Quorain A, al Hamdan AA, Husain A, Qutub H, Ladipo GO. Clinical profile of patients admitted to the coronary care unit with possible myocardial infarction without diagnostic ECG and/or enzyme changes. East Afr Med J 1993; 70(12):777–781.

  • 10

    Agrez MV, Coory M, Cockburn J. Population screening for colorectal carcinoma with fecal-occult blood testing: are we sufficiently informed? Cancer 1998; 82(10):1803–1807.

  • 11

    Allison JE. Review article: faecal occult blood testing for colorectal cancer. Alimentary Pharmacology & Therapeutics 1998; 12(1):1–10.

  • 12

    Anania G, Bazzocchi M, di Loreto C, Risaliti A, Terrosu G, Donini A et al. Percutaneous large core needle biopsy versus surgical biopsy in the diagnosis of breast lesions. Int Surg 1997; 82(1):52–55.

  • 13

    Anthony D. Immediate breast reconstruction following mastectomy for cancer of the breast. Bristol, England: U K National Health Service, South and West Regional Health Authority, 1995; 1995:19.

  • 14

    Antman EM, Seelig MS, Fleischmann K, Lau J, Kuntz K, Berkey CS et al. Magnesium in acute myocardial infarction: scientific, statistical, and economic rationale for its use. Cardiovasc Drugs Ther 1996; 10(3):297–301.

  • 15

    Anwar S, Hall C, Elder JB. Screening for colorectal cancer: present, past and future. European Journal of Surgical Oncology 1998; 24(6):477–486.

  • 16

    Arroll B. Screening: the double edged sword! N Z Med J 1990; 103(894):346–348.

  • 17

    Badgett RG, Tanaka DJ. Is screening for chronic obstructive pulmonary disease justified? Preventive Medicine 1997; 26(4):466–472.

  • 18

    Bains N, Pickett W, Hoey J. The use and impact of incentives in population-based smoking cessation programs: a review. American Journal of Health Promotion 1998; 12(5):307–320.

  • 19

    Barbagelata A, Granger CB, Topol EJ, Worley SJ, Kereiakes DJ, George BS et al. Frequency, significance, and cost of recurrent ischemia after thrombolytic therapy for acute myocardial infarction. TAMI Study Group. Am J Cardiol 1995; 76(14):1007–1013.

  • 20

    Barnes NC, Thwaites RM, Price MJ. The cost-effectiveness of inhaled fluticasone propionate and budesonide in the treatment of asthma in adults and children. Respiratory Medicine 1999; 93(6):402–407.

  • 21

    Barnes PJ. Efficacy of inhaled corticosteroids in asthma. J Allergy Clin Immunol 1998; 102(4 Pt 1):531–538.

  • 22

    Barthel W, Haustein KO. Cost-benefit analysis—a prerequisite of a rational pharmacotherapy in cardiovascular diseases. Timely thrombolysis in the acute myocardial infarction. Int J Clin Pharmacol Ther 1996; 34(7):277–281.

  • 23

    Baur X, Chen Z, Liebers V. Exposure-response relationships of occupational inhalative allergens. Clin Exp Allergy 1998; 28(5):537–544.

  • 24

    Beatt KJ, Fath-Ordoubadi F. Angioplasty for the treatment of acute myocardial infarction. Heart 1997; 78 Suppl 2:12–15.

  • 25

    Bjornson-Benson WM, Stibolt TB, Manske KA, Zavela KJ, Youtsey DJ, Buist AS. Monitoring recruitment effectiveness and cost in a clinical trial. Controlled Clinical Trials 1993; 14(2 Suppl):52S–67S.

  • 26

    Blaiss MS. Outcomes analysis in asthma. JAMA 1997; 278(22):1874–1880.

  • 27

    Blake GH, DeHart RL. Clinical preventive medicine in business and industry: the economic impact. J Health Soc Policy 1994; 6(1):59–70.

  • 28

    Blumenschein K, Johannesson M. Relationship between quality of life instruments, health state utilities, and willingness to pay in patients with asthma. Annals of Allergy, Asthma, & Immunology 1998; 80(2):189–194.

  • 29

    Boersma H, van der Vlugt MJ, Arnold AE, Deckers JW, Simoons ML. Estimated gain in life expectancy. A simple tool to select optimal reperfusion treatment in individual patients with evolving myocardial infarction. Eur Heart J 1996; 17(1):64–75.

  • 30

    Bolin TD. Cost benefit of early diagnosis of colorectal cancer. Scandinavian Journal of Gastroenterology - Supplement 1996; 220:142–146.

  • 31

    Bond JH. Fecal occult blood testing for colorectal cancer. Can we afford not to do this? Gastroenterology Clinics of North America 1997; 26(1):57–70.

  • 32

    Bourke JP, Richards DA, Ross DL, Wallace EM, McGuire MA, Uther JB. Routine programmed electrical stimulation in survivors of acute myocardial infarction for prediction of spontaneous ventricular tachyarrhythmias during follow-up: results, optimal stimulation protocol and cost-effective screening. J Am Coll Cardiol 1991; 18(3):780–788.

  • 33

    Breuninger K. The utility of flexible sigmoidoscopy as a screening tool for colon cancer. J Am Acad Nurse Pract 1996; 8(9):431–432.

  • 34

    Brown AD, Garber AM. Cost effectiveness of coronary heart disease prevention strategies in adults. Pharmacoeconomics 1998; 14(1):27–48.

  • 35

    Brown DC. Smoking cessation in pregnancy. Canadian Family Physician 1996; 42:102–105.

  • 36

    Brown ML, Kessler LG. Use of gene tests to detect hereditary predisposition to cancer: what do we know about cost effectiveness? Int J Cancer 1996; 69(1):55–57.

  • 37

    Bry JD, Belkin M, O'Donnell TF, Jr., Mackey WC, Udelson JE, Schmid CH et al. An assessment of the positive predictive value and cost-effectiveness of dipyridamole myocardial scintigraphy in patients undergoing vascular surgery. J Vasc Surg 1994; 19(1):112–121.

  • 38

    Bukstein DA. Incorporating quality of life data into managed care formulary decisions: a case study with salmeterol. American Journal of Managed Care 1997; 3(11):1701–1706.

  • 39

    Bussey HI, Chiquette E. Costs of oral anticoagulation treatment after myocardial infarction. JAMA 1995; 274(20):1588–1589.

  • 40

    Byers T, Gorsky R. Estimates of costs and effects of screening for colorectal cancer in the United States. Cancer 1992; 70(5 Suppl):1288–1295.

  • 41

    Cady B. Cost-effective preoperative evaluation, operative treatment, and postoperative follow-up in the breast cancer patient. Surgical Clinics of North America 1996; 76(1):25–34.

  • 42

    Cairns JA, Markham BA. Economics and efficacy in choosing oral anticoagulants or aspirin after myocardial infarction. JAMA 1995; 273(12):965–967.

  • 43

    Campbell S. New AHCPR guideline targets and cost of smoking cessation programs. Health Care Strategic Management 1996; 14(6):16–17.

  • 44

    Cantor SB. Cost-effectiveness analysis, extended dominance, and ethics: a quantitative assessment. Med Decis Making 1994; 14(3):259–265.

  • 45

    Carpenter CR. Promoting tobacco cessation in the military: an example for primary care providers. Military Medicine 1998; 163(8):515–518.

  • 46

    Chapman KR, Dales RE, Chan-Yeung M, Cote J. Future research in asthma education. Chest 1994; 106(4 Suppl):270S–273S.

  • 47

    Ciatto S, Rosselli DT, Ambrogetti D, Bravetti P, Catarzi S, Morrone D et al. Solid nonpalpable breast lesions. Success and failure of guided fine-needle aspiration cytology in a consecutive series of 2444 cases. Acta Radiol 1997; 38(5):815–820.

  • 48

    Clark AB, Holt JM. Identifying and managing patients with hyperlipidemia. Am J Manag Care 1997; 3(8):1211–1219.

  • 49

    Cockburn J, Ruth D, Silagy C, Dobbin M, Reid Y, Scollo M et al. Randomised trial of three approaches for marketing smoking cessation programmes to Australian general practitioners. BMJ 1992; 304(6828):691–694.

  • 50

    Cohen DR, Fowler GH. Economic implications of smoking cessation therapies: a review of economic appraisals. Pharmacoeconomics 1993; 4(5):331–344.

  • 51

    Cohn JR, Caliguiri LA, Gallagher PE, Schenkel EJ. Commentary: prevention and cost of asthma—a model for cost effective health care. Allergy Proc 1994; 15(1):39–41.

  • 52

    Cole RE, Wagner DE. The pros and cons of a mass-media colorectal screening program. Prog Clin Biol Res 1990; 339:325–330.

  • 53

    Compas BE, Haaga DA, Keefe FJ, Leitenberg H, Williams DA. Sampling of empirically supported psychological treatments from health psychology: smoking, chronic pain, cancer, and bulimia nervosa. J Consult Clin Psychol 1998; 66(1):89–112.

  • 54

    Crealey GE, McElnay JC, Maguire TA, O'Neill C. Costs and effects associated with a community pharmacy-based smoking-cessation programme. Pharmacoeconomics 1998; 14(3):323–333.

  • 55

    Croghan IT, Offord KP, Evans RW, Schmidt S, Gomez-Dahl LC, Schroeder DR et al. Cost-effectiveness of treating nicotine dependence: the Mayo Clinic experience. Mayo Clinic Proceedings 1997; 72(10):917–924.

  • 56

    Curry SJ, Grothaus LC, McAfee T, Pabiniak C. Use and cost effectiveness of smoking-cessation services under four insurance plans in a health maintenance organization. New England Journal of Medicine 1998; 339(10):673–679.

  • 57

    Davis R, McTavish D. Budesonide. An appraisal of the basis of its pharmacoeconomic and quality-of-life benefits in asthma. Pharmacoeconomics 1995; 7(5):457–470.

  • 58

    Demoly P, Chung KF. Pharmacology of corticosteroids. Respir Med 1998; 92(3):385–394.

  • 59

    Donald JJ, Burhenne HJ. Colorectal cancer. Can we lower the death rate in the 1990s? Canadian Family Physician 1993; 39:107–114.

  • 60

    Donaldson C. Economic evaluation: an ethical imperative? Inflammatory Bowel Diseases 1998; 4(1):40–44.

  • 61

    Donovan JM, Syngal S. Colorectal cancer in women: an underappreciated but preventable risk. Journal of Womens Health 1998; 7(1):45–48.

  • 62

    Dunbabin D. Cost-effective intervention in stroke. Pharmacoeconomics 1992; 2(6):468–499.

  • 63

    Early DS, Marshall JB. Is routine screening for colorectal cancer justifiable? These gastroenterologists say YES. Postgraduate Medicine 1997; 102(1):48–52.

  • 64

    Eddy DM. Clinical decision making: from theory to practice. Cost-effectiveness analysis. Is it up to the task? JAMA 1992; 267(24):3342–3348.

  • 65

    Effron MB, Morales RE. Thrombolytic therapy for acute myocardial infarction in the 1990s. Md Med J 1991; 40(6):485–491.

  • 66

    Ehleben CM, Winters PM, Wheeler CJ, Shlaer SM. Evaluation of a colorectal cancer screening program. Prog Clin Biol Res 1990; 339:351–360.

  • 67

    Eisenstein EL, Mark DB, Califf RM. Importance of cost and quality of life in decisions about routine angiography after acute myocardial infarction. The role of cost- effectiveness models. Circulation 1996; 94(5):869–871.

  • 68

    Elixhauser A. The costs of smoking and the cost effectiveness of smoking-cessation programs. J Public Health Policy 1990; 11(2):218–237.

  • 69

    Erfurt JC, Foote A, Heirich MA. The cost-effectiveness of work-site wellness programs for hypertension control, weight loss, and smoking cessation. Journal of Occupational Medicine 1991; 33(9):962–970.

  • 70

    Ernster VL, Barclay J, Kerlikowske K, Grady D, Henderson C. Incidence of and treatment for ductal carcinoma in situ of the breast. JAMA 1996; 275(12):913–918.

  • 71

    Escudero AI, Sanchez-Guerrero IM, Mora AM, Soriano V, Lopez JD, Garcia FJ et al. Cost-effectiveness of various methods of diagnosing hypersensitivity to Alternaria. Allergologia et Immunopathologia 1993; 21(4):153–157.

  • 72

    Evans R, LeBailly S, Gordon KK, Sawyer A, Christoffel KK, Pearce B. Restructuring asthma care in a hospital setting to improve outcomes. Chest 1999; 116(4 Suppl 1):210S–216S.

  • 73

    Every NR, Parsons LS, Fihn SD, Larson EB, Maynard C, Hallstrom AP et al. Long-term outcome in acute myocardial infarction patients admitted to hospitals with and without on-site cardiac catheterization facilities. MITI Investigators. Myocardial Infarction Triage and Intervention. Circulation 1997; 96(6):1770–1775.

  • 74

    Faivre J, Tazi MA, Autier P, Bleiberg H. Should there be mass screening using faecal occult blood tests for colorectal cancer? European Journal of Cancer 1998; 34(6):773–780.

  • 75

    Fallen EL, Cairns J, Dafoe W, Frasure-Smith N, Genest J, Jr., Massel D et al. Management of the postmyocardial infarction patient: a consensus report–revision of 1991 CCS guidelines. Can J Cardiol 1995; 11(6):477–486.

  • 76

    Fath-Ordoubadi F, Beatt KJ. Angioplasty and acute myocardial infarction. Lancet 1993; 342(8875):861–862.

  • 77

    Fenn P, Gray AM, McGuire A. The cost-effectiveness of thrombolytic therapy following acute myocardial infarction. Br J Clin Pract 1991; 45(3):181–184.

  • 78

    Fletcher RH. Should all people over the age of 50 have regular fecal occult-blood tests? If it works, why not do it? New England Journal of Medicine 1998; 338(16):1153–4discussion.

  • 79

    Folgering H, Rooyakkers J, Herwaarden C. Education and cost/benefit ratios in pulmonary patients. Monaldi Arch Chest Dis 1994; 49(2):166–168.

  • 80

    Franzosi MG, Maggioni AP, Santoro E, Tognoni G, Cavalieri E. Cost-effectiveness analysis of early lisinopril use in patients with acute myocardial infarction. Results from GISSI-3 trial. Pharmacoeconomics 1998; 13(3):337–346.

  • 81

    Frisell J, Lidbrink E. The Stockholm Mammographic Screening Trial: Risks and benefits in age group 40–49 years. J Natl Cancer Inst Monogr 1997;(22):49–51.

  • 82

    Gal R, Ahmad M. Cost-saving approach to normal technetium-99m sestamibi myocardial perfusion scan. Am J Cardiol 1996; 78(9):1047–1049.

  • 83

    Garvican L. Planning for a possible national colorectal cancer screening programme. Journal of Medical Screening 1998; 5(4):187–194.

  • 84

    Gelfand DW. Colorectal cancer. Screening strategies. Radiologic Clinics of North America 1997; 35(2):431–438.

  • 85

    Gelfand DW, Ott DJ. The economic implications of radiologic screening for colonic cancer. AJR Am J Roentgenol 1991; 156(5):939–943.

  • 86

    Gelfand DW. Screening for colon cancer: economics and related considerations. Seminars in Roentgenology 1996; 31(2):170–176.

  • 87

    Gelfand DW, Ott DJ. Colon cancer screening: where radiology fits in. Diagn Imaging (San Franc) 1993; 15(7):75–77.

  • 88

    Gergen PJ, Goldstein RA. Does asthma education equal asthma intervention? International Archives of Allergy & Immunology 1995; 107(1–3):166–168.

  • 89

    Gianetti J, Gensini G, De Caterina R. A cost-effectiveness analysis of aspirin versus oral anticoagulants after acute myocardial infarction in Italy—equivalence of costs as a possible case for oral anticoagulants. Thromb Haemost 1998; 80(6):887–893.

  • 90

    Gillis JC, Wagstaff AJ, Goa KL. Alteplase. A reappraisal of its pharmacological properties and therapeutic use in acute myocardial infarction. Drugs 1995; 50(1):102–136.

  • 91

    Glynn TJ, Manley MW, Pechacek TF. Physician-initiated smoking cessation program: the National Cancer Institute trials. Prog Clin Biol Res 1990; 339:11–25.

  • 92

    Goa KL, Balfour JA, Zuanetti G. Lisinopril. A review of its pharmacology and clinical efficacy in the early management of acute myocardial infarction. Drugs 1996; 52(4):564–588.

  • 93

    Goldman LK, Glantz SA. Evaluation of antismoking advertising campaigns. JAMA 1998; 279(10):772–777.

  • 94

    Goodnough LT, Monk TG. Evolving concepts in autologous blood procurement and transfusion: case reports of perisurgical anemia complicated by myocardial infarction. Am J Med 1996; 101(2A):33S–37S.

  • 95

    Gourlay S. The pros and cons of transdermal nicotine therapy. Medical Journal of Australia 1994; 160(3):152–159.

  • 96

    Greenwald P, Stern HR. Role of biology and prevention in aerodigestive tract cancers. Journal of the National Cancer Institute Monographs (13):3–14, 1992; 1992.(13).

  • 97

    Gruffydd-Jones K. Quality-of-life measures in asthma—do they matter to the GP? British Journal of General Practice 1997; 47(419):392–394.

  • 98

    Gyrd-Hansen D, Sogaard J, Kronborg O. Colorectal cancer screening: efficiency and effectiveness. Health Economics 1998; 7(1):9–20.

  • 99

    Haddow JE, Knight GJ, Kloza EM, Palomaki GE, Wald NJ. Cotinine-assisted intervention in pregnancy to reduce smoking and low birthweight delivery. Br J Obstet Gynaecol 1991; 98(9):859–865.

  • 100

    Haigh R, Castleden M, Woods K, Fletcher S, Bowns I, Gibson M et al. Management of myocardial infarction in the elderly: admission and outcome on a coronary care unit. Health Trends 1991; 23(4):154–157.

  • 101

    Hardcastle JD, Robinson MH. Screening for colorectal cancer. European Journal of Cancer 1992; 28A(11):1778–1780.

  • 102

    Hays JT, Dale LC, Hurt RD, Croghan IT. Trends in smoking-related diseases. Why smoking cessation is still the best medicine. Postgraduate Medicine 1998; 104(6):56–62.

  • 103

    Heine JA, Rothenberger DA. Cost-effective management of colon and rectal cancer. World J Surg 1991; 15(5):597–604.

  • 104

    Heinen L, Peterson E, Pion K, Leatherman S. Quality evaluation in a managed care system: comparative data to assess health plan performance. Managed Care Quarterly 1993; 1(1):62–76.

  • 105

    Hilleman DE, Lucas BD, Jr., Mohiuddin SM, Holmberg MJ. Cost-minimization analysis of intravenous adenosine and dipyridamole in thallous chloride TI 201 SPECT myocardial perfusion imaging. Ann Pharmacother 1997; 31(9):974–979.

  • 106

    Hillner BE. Decision analysis: MIBI imaging of nonpalpable breast abnormalities. J Nucl Med 1997; 38(11):1772–1778.

  • 107

    Hillner BE, Bear HD, Fajardo LL. Estimating the cost-effectiveness of stereotaxic biopsy for nonpalpable breast abnormalities: a decision analysis model. Academic Radiology 1996; 3(4):351–360.

  • 108

    Hillner BE, Smith TJ. Cost effectiveness and other assessments of adjuvant therapies for early breast cancer. Oncology 1995; 9(11 Suppl):129–134.

  • 109

    Hillner BE. Economic and cost-effectiveness issues in breast cancer treatment. Semin Oncol 1996; 23(1 Suppl 2):98–104.

  • 110

    Hines D. Young smokers' attitudes about methods for quitting smoking: barriers and benefits to using assisted methods. Addictive Behaviors 1996; 21(4):531–535.

  • 111

    Hlatky MA, Owens DK. Cost-effectiveness of tests to assess the risk of sudden death after acute myocardial infarction. J Am Coll Cardiol 1998; 31(7):1490–1492.

  • 112

    Hu TW, Sung HY, Keeler TE. The state antismoking campaign and the industry response: the effects of advertising on cigarette consumption in California. American Economic Review 1995; 85(2):85–90.

  • 113

    Huckell VF, Bernstein V, Crowell R, Dagenais GR, Higginson LA, Isserow S et al. Angiotensin-converting enzyme inhibition in myocardial infarction—Part 2: Clinical issues and controversies. Can J Cardiol 1997; 13(2):173–182.

  • 114

    Hughes JR. The future of smoking cessation therapy in the United States. Addiction 1996; 91(12):1797–1802.

  • 115

    Iunes RF. On the economic analysis of response to preventive measures. Revista de Saude Publica 1991; 25(4):243–250.

  • 116

    Jaffe AS. More rapid biochemical diagnosis of myocardial infarction: necessary? Prudent? Cost effective? Clin Chem 1993; 39(8):1567–1569.

  • 117

    Jamali FR, Kurtzman SH, Deckers PJ. Role of axillary dissection in mammographically detected breast cancer. Surgical Oncology Clinics of North America 1997; 6(2):343–358.

  • 118

    Jednak MA, Nostrant TT. Screening for colorectal cancer. Primary Care 1998; Clinics in Office Practice.;25(2):293–308.

  • 119

    Katelaris CH. Successful immunotherapy. A partnership between consultant and general practitioner. Aust Fam Physician 1998; 27(8):687–692.

  • 120

    Kazzaz Y, Levey S, McKnight M, Schnitzler MA. Opportunities for potential cost saving in the management of acute myocardial infarction. Best Pract Benchmarking Healthc 1997; 2(4):178–182.

  • 121

    Kellett J, Clarke J. Comparison of “accelerated” tissue plasminogen activator with streptokinase for treatment of suspected myocardial infarction. Med Decis Making 1995; 15(4):297–310.

  • 122

    Korhonen HJ, Niemensivu H, Piha T, Koskela K, Wiio J, Johnson CA et al. National TV smoking cessation program and contest in Finland. Preventive Medicine 1992; 21(1):74–87.

  • 123

    Krahn M. Issues in the cost-effectiveness of asthma education. Chest 1994; 106(4 Suppl):264S–269S.

  • 124

    Krishnamoorthy M, Mintz A, Liem T, Applebaum H. Diagnosis and treatment of respiratory symptoms of initially unsuspected gastroesophageal reflux in infants. Am Surg 1994; 60(10):783–785.

  • 125

    Kronborg O, Wahrendorf J. Colorectal cancer screening: methods, benefits and costs. European Journal of Cancer 1994; 30A(6):877–879.

  • 126

    Kronborg O. Population screening for colorectal cancer, the goals and means. Annals of Medicine 1991; 23(4):373–379.

  • 127

    Krumholz HM, Chen J, Murillo JE, Cohen DJ, Radford MJ. Clinical correlates of in-hospital costs for acute myocardial infarction in patients 65 years of age and older. Am Heart J 1998; 135(3):523–531.

  • 128

    Kupersmith J, Holmes-Rovner M, Hogan A, Rovner D, Gardiner J. Cost-effectiveness analysis in heart disease, Part II: Preventive therapies. Progress in Cardiovascular Diseases 1995; 37(4):243–271.

  • 129

    Kwon AH, Yamada O, Uetsuji S, Matsui Y, Kamiyama Y. Prophylactic laparoscopic ovarian ablation for premenopausal breast cancer: medical and economic efficacy. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 1997; 7(3):223–227.

  • 130

    Labott SM, Preisman RC, Popovich JJ, Iannuzzi MC. Health care utilization of somatizing patients in a pulmonary subspecialty clinic. Psychosomatics 1995; 36(2):122–128.

  • 131

    Lambert R. Role of endoscopy in the prevention of digestive cancer: application to colorectal cancer. Endoscopy 1998; 30(7):628–640.

  • 132

    Lando HA, Loken B, Howard-Pitney B, Pechacek T. Community impact of a localized smoking cessation contest. Am J Public Health 1990; 80(5):601–603.

  • 133

    Laupacis A, Labelle R, Goeree R, Cairns J. The cost-effectiveness of routine post myocardial infarction exercise stress testing. Can J Cardiol 1990; 6(4):157–163.

  • 134

    Law M, Tang JL. An analysis of the effectiveness of interventions intended to help people stop smoking. Archives of Internal Medicine 1995; 155(18):1933–1941.

  • 135

    Lickteig S, Knutson D, Yoast R, Remington PL. Wisconsin's experience with the national nicotine patch giveaway. Wisconsin Medical Journal 1993; 92(11):631–632.

  • 136

    Lieberman D. How to screen for colon cancer. Annu Rev Med 1998; 49:163–172.

  • 137

    Lieberman D, Sleisenger MH. Is it time to recommend screening for colorectal cancer? Lancet 1996; 348(9040):1463–1464.

  • 138

    Lieberman D. Cost-effectiveness of colon cancer screening. Am J Gastroenterol 1991; 86(12):1789–1794.

  • 139

    Lieu TA, Quesenberry CP, Sorel ME, Mendoza GR, Leong AB. Computer-based models to identify high-risk children with asthma. American Journal of Respiratory & Critical Care Medicine 1998; 157(4 Pt 1):1173–1180.

  • 140

    Liljas B, Lahdensuo A. Is asthma self-management cost-effective? Patient Educ Couns 1997; 32(1 Suppl):S97–104.

  • 141

    Loo R. Policies and procedures in the workplace: how health care organizations compare. Healthc Manag Forum 1993; 6(2):39–43.

  • 142

    Lum DF, Welton ML. Benign colorectal polyps. Endoscopic surveillance guidelines and effects on colorectal cancer risk. Surgical Oncology Clinics of North America 1996; 5(3):621–632.

  • 143

    Lusk SL. Health promotion and disease prevention in the worksite. Annual Review of Nursing Research 1997; 15:187–213.

  • 144

    Magid DJ, Koepsell TD, Every NR, Martin JS, Siscovick DS, Wagner EH et al. Absence of association between insurance copayments and delays in seeking emergency care among patients with myocardial infarction. N Engl J Med 1997; 336(24):1722–1729.

  • 145

    Mamlok R. A cost-effective approach to the diagnosis and treatment of the wheezing infant. Allergy Asthma Proc 1997; 18(3):149–152.

  • 146

    Mantovani LG, Belisari A, Szucs TD. Captopril in the management of patients after acute myocardial infarctions. A cost effectiveness analysis in Italy. Pharmacol Res 1998; 37(5):345–351.

  • 147

    Markowitz AJ, Winawer SJ. Screening and surveillance for colorectal carcinoma. Hematology - Oncology Clinics of North America 1997; 11(4):579–608.

  • 148

    Maron DJ. Nonlipid primary and secondary prevention strategies for coronary heart disease [published erratum appears in Clin Cardiol 1996 Jul;19(7):602]. Clinical Cardiology 1919; 19(5):419–423.

  • 149

    Massie RJ, Mellis CM. The economic aspects of drug delivery in asthma. Pharmacoeconomics 1997; 11(5):398–407.

  • 150

    Matallana RH. Comprehensive breast diagnosis. European Journal of Gynaecological Oncology 1993; 14(4):292–295.

  • 151

    Mazur L, Miller J, Fox L, Howland R. Variation in the process of pediatric asthma care. Journal for Healthcare Quality 1996; 18(3):11–17.

  • 152

    McClure JB, Skaar K, Tsoh J, Wetter DW, Cinciripini PM, Gritz ER. Smoking cessation. 3: Needed healthcare policy changes. Behavioral Medicine 1997; 23(1):29–34.

  • 153

    McGlynn EA. Choosing chronic disease measures for HEDIS: conceptual framework and review of seven clinical areas. Managed Care Quarterly 1996; 4(3):54–77.

  • 154

    McMurray JJ, McGuire A, Davie AP, Hughes D. Cost-effectiveness of different ACE inhibitor treatment scenarios post- myocardial infarction. Eur Heart J 1997; 18(9):1411–1415.

  • 155

    Meduri GU. Noninvasive positive-pressure ventilation in patients with acute respiratory failure. Clin Chest Med 1996; 17(3):513–553.

  • 156

    Meenan RT, Stevens VJ, Hornbrook MC, La Chance PA, Glasgow RE, Hollis JF et al. Cost-effectiveness of a hospital-based smoking cessation intervention. Medical Care 1998; 36(5):670–678.

  • 157

    Milne RJ. Evaluation of the pharmacoeconomic literature. Pharmacoeconomics 1994; 6(4):337–345.

  • 158

    Molken MP, van Doorslaer EK, Rutten FF. Economic appraisal of asthma and COPD care: a literature review 1980–1991. Soc Sci Med 1992; 35(2):161–175.

  • 159

    Morrow M. When can stereotactic core biopsy replace excisional biopsy?—A clinical perspective. Breast Cancer Res Treat 1995; 36(1):1–9.

  • 160

    Naylor CD, Bronskill S, Goel V. Cost-effectiveness of intravenous thrombolytic drugs for acute myocardial infarction. Can J Cardiol 1993; 9(6):553–558.

  • 161

    Nelson RL. Screening of average-risk individuals for colorectal cancer and postoperative evaluation of patients with colorectal cancer. Surgical Clinics of North America 1996; 76(1):35–45.

  • 162

    Nightingale CH. Cost comparison of beta 2-agonist bronchodilators used in the treatment of asthma. Pharmacotherapy 1995; 15(5):677–681.

  • 163

    Niv Y. Does a risk questionnaire add anything to a colorectal screening project? Report of a 3-year screening experience. Journal of Clinical Gastroenterology 1992; 15(1):33–36.

  • 164

    Niv Y, Gold B, Fraser GM. Screening for colonic neoplastic lesions using flexible sigmoidoscopy in employees of a nuclear research center and members of collective settlements. Isr J Med Sci 1996; 32(12):1167–1172.

  • 165

    Norum J. Prevention of colorectal cancer: a cost-effectiveness approach to a screening model employing sigmoidoscopy. Annals of Oncology 1998; 9(6):613–618.

  • 166

    O'Brien KP. Asthma in the managed care setting. Current Opinion In Pulmonary Medicine 1997; 3(1):56–60.

  • 167

    O'Brien KP. Managed care and the treatment of asthma. J Asthma 1995; 32(5):325–334.

  • 168

    Oldridge NB. Cardiac rehabilitation and risk factor management after myocardial infarction. Clinical and economic evaluation. Wien Klin Wochenschr Suppl 1997; 2:6–16.

  • 169

    Oliveira M, Staunton A, Camm AJ, Malik M. Stepwise strategy on the cost of risk stratification after acute myocardial infarction: a retrospective simulation study. Pacing Clin Electrophysiol 1998; 21(3):603–609.

  • 170

    Ostro B, Chestnut L. Assessing the health benefits of reducing particulate matter air pollution in the United States. Environmental Research 1998; 76(2):94–106.

  • 171

    Papo MC, Frank J, Thompson AE. A prospective, randomized study of continuous versus intermittent nebulized albuterol for severe status asthmaticus in children. Crit Care Med 1993; 21(10):1479–1486.

  • 172

    Parikh HK, Badwe RA, Ash CM, Hamed H, Freitas RJ, Chaudary MA et al. Early drain removal following modified radical mastectomy: a randomized trial. Journal of Surgical Oncology 1992; 51(4):266–269.

  • 173

    Pashkow P, Ades PA, Emery CF, Frid DJ, Houston-Miller N, Peske G et al. Outcome measurement in cardiac and pulmonary rehabilitation. AACVPR Outcomes Committee. American Association of Cardiovascular and Pulmonary Rehabilitation. Journal of Cardiopulmonary Rehabilitation 1995; 15(6):394–405.

  • 174

    Patterson R, De Swarte RD, Grammer LC, Greenberger PA, Harris KE, McGrath K et al. Evolution of patient care, education, and research in asthma by one academic team of investigators over 35 years: the Northwestern University Medical School Division of Allergy-Immunology experience (Part Two). Allergy Proceedings 1994; 15(4):223–232.

  • 175

    Paul CL, Sanson-Fisher RW. Experts' agreement on the relative effectiveness of 29 smoking reduction strategies. Preventive Medicine 1996; 25(5):517–526.

  • 176

    Pearce MJ, Begg EJ. Encouraging consensus cost effective drug therapy: five years experience with a hospital drug utilisation review programme. N Z Med J 1997; 110(1040):92–95.

  • 177

    Pelc A, Dardenne J, Frelon JH, Hanania G. Incremental cost-effectiveness ratio of alteplase in patients with acute myocardial infarction in the French setting. Pharmacoeconomics 1997; 11(6):595–605.

  • 178

    Peters DH, Benfield P. Metoprolol: a pharmacoeconomic and quality-of-life evaluation of its use in hypertension, post-myocardial infarction and dilated cardiomyopathy [published erratum appears in Pharmacoeconomics 1995 Jun;7(6):554]. Pharmacoeconomics 1994; 6(4):370–400.

  • 179

    Peters DH, Faulds D. Salmeterol. An appraisal of its quality-of-life benefits and potential pharmacoeconomic positioning in asthma. Pharmacoeconomics 1995; 7(6):562–574.

  • 180

    Pettine S, Place R, Babu S, Williard W, Kim D, Carter P. Stereotactic breast biopsy is accurate, minimally invasive, and cost effective. Am J Surg 1996; 171 (5):474–476.

  • 181

    Pharoah PD, Sanderson SP. Health promotion in primary care: modelling the impact of intervention on coronary heart disease and stroke. Journal of Public Health Medicine 1995; 17(2):150–156.

  • 182

    Phillips CJ, Prowle MJ. Economics of a reduction in smoking: case study from Heartbeat Wales. Journal of Epidemiology & Community Health 1993; 47(3):215–223.

  • 183

    Plans-Rubio P. Cost-effectiveness of cardiovascular prevention programs in Spain. International Journal of Technology Assessment in Health Care 1998; 14(2):320–330.

  • 184

    Playford DA, Watts GF. Management of lipid disorders in the elderly. Drugs Aging 1997; 10(6):444–462.

  • 185

    Por CP, Evans MF. Peak flow meters for asthma patients. Do they up the benefits or up the costs? Canadian Family Physician 1998; 44:1265–1267.

  • 186

    Prager D, Grundfest-Broniatowski S, Lerner HJ, Margolese RG, Dimitrov N, Silverman P. Breast cancer: are imaging studies cost effective following breast cancer and adjuvant therapy? Seminars in Oncology 1995; 22(4):xiii–xixx.

  • 187

    Price DB, Appleby JL. Fluticasone propionate: an audit of outcomes and cost-effectiveness in primary care. Respiratory Medicine 1998; 92(2):351–353.

  • 188

    Price DB, Cargill K, Wolfe S, Darby H. Salmeterol xinafoate: an analysis of outcomes and cost-effectiveness using a primary care database. Respiratory Medicine 1998; 92(11):1302–1304.

  • 189

    Provenzale D, Lipscomb J. Cost-effectiveness: definitions and use in the gastroenterology literature. American Journal of Gastroenterology 1996; 91(8):1488–1493.

  • 190

    Ransohoff DF, Lang CA. Screening for colorectal cancer with the fecal occult blood test: a background paper. American College of Physicians. Annals of Internal Medicine 1997; 126(10):811–822.

  • 191

    Ratcliffe J, Cairns J, Platt S. Cost effectiveness of a mass media-led anti-smoking campaign in Scotland. Tob Control 1997; 6(2):104–110.

  • 192

    Reid D. Tobacco control: overview. British Medical Bulletin 1996; 52(1):108–120.

  • 193

    Richards JMJ, Hemstreet MP. Measures of life quality, role performance, and functional status in asthma research. Am J Respir Crit Care Med 1994; 149(2 Pt 2):S31–S39.

  • 194

    Rigby K, Silagy C, Crockett A. Can resource use be extracted from randomized controlled trials to calculate costs? A review of smoking cessation interventions in general practice. International Journal of Technology Assessment in Health Care 1996; 12(4):714–720.

  • 195

    Robinson MB, Thompson E, Black NA. A model for estimating the cost-utility of clinical audit. The example of thrombolysis for suspected acute myocardial infarction. Int J Technol Assess Health Care 1998; 14(1):161–171.

  • 196

    Robinson MB, Thompson E, Black NA. Why is evaluation of the cost effectiveness of audit so difficult? The example of thrombolysis for suspected acute myocardial infarction. Qual Health Care 1998; 7(1):19–26.

  • 197

    Robinson MH, Hardcastle JD. Should we be screening for colorectal cancer? British Medical Bulletin 1998; 54(4):807–821.

  • 198

    Rohl BJ, Meyer LC, Lung CL. Patient-centered asthma care: a community-based multidisciplinary model. Medical Interface 1994; 7(1):48–50.

  • 199

    Rubin M, Horiuchi K, Joy N, Haun W, Read R, Ratzer E et al. Use of fine needle aspiration for solid breast lesions is accurate and cost-effective. Am J Surg 1997; 174(6):694–696.

  • 200

    Rutherford JD. Risk stratification after myocardial infarction in the thrombolytic era. Curr Opin Cardiol 1996; 11(4):428–433.

  • 201

    Schadlich PK, Huppertz E, Brecht JG. Cost-effectiveness analysis of ramipril in heart failure after myocardial infarction. Economic evaluation of the Acute Infarction Ramipril Efficacy (AIRE) study for Germany from the perspective of Statutory Health Insurance. Pharmacoeconomics 1998; 14(6):653–669.

  • 202

    Schauffler HH, Parkinson MD. Health insurance coverage for smoking cessation services. Health Education Quarterly 1920; 20(2):185–206.

  • 203

    Schmier JK, Leidy NK. The complexity of treatment adherence in adults with asthma: challenges and opportunities. J Asthma 1998; 35(6):455–472.

  • 204

    Schultz LF, Diepgen T, Svensson A. The occurrence of atopic dermatitis in north Europe: an international questionnaire study. Journal of the American Academy of Dermatology 1996; 34(5 Pt 1):760–764.

  • 205

    Schultz MA, van Servellen G, Chang BL, McNeese-Smith D, Waxenberg E. The relationship of hospital structural and financial characteristics to mortality and length of stay in acute myocardial infarction patients. Outcomes Manag Nurs Pract 1998; 2(3):130–136.

  • 206

    Self T, Nolan S. Long-term management of asthma: how to improve outcomes. American Journal of Managed Care 1997; 3(9):1425–38quiz.

  • 207

    Severson HH, Andrews JA, Lichtenstein E, Wall M, Akers L. Reducing maternal smoking and relapse: long-term evaluation of a pediatric intervention. Preventive Medicine 1997; 26(1):120–130.

  • 208

    Shumaker SA, Brooks MM, Schron EB, Hale C, Kellen JC, Inkster M et al. Gender differences in health-related quality of life among postmyocardial infarction patients: brief report. CAST Investigators. Cardiac Arrhythmia Suppression Trials. Womens Health 1997; 3(1):53–60.

  • 209

    Slevin ML. Quality of life: philosophical question or clinical reality? BMJ 1992; 305(6851):466–469.

  • 210

    Smeeth L, Fowler G. Nicotine replacement therapy for a healthier nation. Nicotine replacement is cost effective and should be prescribable on the NHS. BMJ 1998; 317(7168):1266–1267.

  • 211

    Smith MD, McGhan WF. Attacking expenditures for asthma. Business & Health 1997; 15(4):67–68.

  • 212

    Soo MS. Imaging-guided core biopsies in the breast. South Med J 1998; 91(11):994–1000.

  • 213

    Stern HS. Technologic and economic considerations of three old, yet new, imaging procedures. Academic Radiology 1996; 3 Suppl 1:S147–S149.

  • 214

    Stevermer J. Cost-effectiveness of the nicotine patch. Journal of Family Practice 1996; 43(2):125–126.

  • 215

    Sullivan S, Elixhauser A, Buist AS, Luce BR, Eisenberg J, Weiss KB. National Asthma Education and Prevention Program working group report on the cost effectiveness of asthma care. American Journal of Respiratory & Critical Care Medicine 1996; 154(3 Pt 2):S84–S95.

  • 216

    Sullivan SD, Weiss KB. Assessing cost-effectiveness in asthma care: building an economic model to study the impact of alternative intervention strategies. Allergy 1993; 48(17 Suppl):146–52discussion.

  • 217

    Tannock IF, Belanger D. Use of a physician-directed questionnaire to define a consensus about management of breast cancer: implications for assessing costs and benefits of treatment. J Natl Cancer Inst Monogr 1992;(11):137–142.

  • 218

    Tillgren P, Rosen M, Haglund BJ, Ainetdin T, Lindholm L, Holm LE. Cost–effectiveness of a tobacco 'quit and win' contest in Sweden. Health Policy 1993; 26(1):43–53.

  • 219

    Towler B, Irwig L, Glasziou P, Haas M, Plunkett A, Salkeld G. The potential benefits and harms of screening for colorectal cancer. Australian Journal of Public Health 1995; 19(1):24–28.

  • 220

    Tsevat J. Impact and cost-effectiveness of smoking interventions. American Journal of Medicine 1992; 93(1A):43S–47S.

  • 221

    Turner-Boutle M, Sheldon T, Smith GD, Ebrahim S. On the evidence. Cholesterol and coronary heart disease screening & treatment. Health Service Journal 1998; 108(5593):36–37.

  • 222

    Ubel PA, DeKay ML, Baron J, Asch DA. Cost-effectiveness analysis in a setting of budget constraints—is it equitable? N Engl J Med 1996; 334(18):1174–1177.

  • 223

    Van Dam J, Bond JH, Sivak MVJ. Fecal occult blood screening for colorectal cancer. Archives of Internal Medicine 1995; 155(22):2389–2402.

  • 224

    Vasen HF, van Ballegooijen M, Buskens E, Kleibeuker JK, Taal BG, Griffioen G et al. A cost-effectiveness analysis of colorectal screening of hereditary nonpolyposis colorectal carcinoma gene carriers. Cancer 1998; 82(9):1632–1637.

  • 225

    Verani MS. Diagnosis and management of acute myocardial infarction. J Nucl Cardiol 1997; 4(2 Pt 2):S158–S163.

  • 226

    Vogt TM, Hollis JF, Lichtenstein E, Stevens VJ, Glasgow R, Whitlock E. The medical care system and prevention: the need for a new paradigm. Hmo Practice 1998; 12(1):5–13.

  • 227

    Voss GB, Hasman A, Rutten F, de Zwaan C, Carpay JJ. Explaining cost variations in DRGs 'Acute Myocardial Infarction' by severity of illness. Health Policy 1994; 28(1):37–50.

  • 228

    Wagner JL, Herdman RC, Wadhwa S. Cost effectiveness of colorectal cancer screening in the elderly. Annals of Internal Medicine 1991; 115(10):807–817.

  • 229

    Wait SH. Economic evaluation of endocrine therapy in the treatment of breast cancer. Anticancer Drugs 1998; 9(10):849–857.

  • 230

    Walker A, Whynes DK. Participation and screening programmes for colorectal cancer: more would be better? Journal of Health Economics 1991; 10(2):207–225.

  • 231

    Wallace JE, Sayler C, McDowell NG, Moseley HS. The role of stereotactic biopsy in assessment of nonpalpable breast lesions. Am J Surg 1996; 171(5):471–473.

  • 232

    Warner KE. Smoking out the incentives for tobacco control in managed care settings. Tobacco Control 1998; 7 Suppl:S50–S54.

  • 233

    Warner KE. Cost effectiveness of smoking-cessation therapies. Interpretation of the evidence- and implications for coverage. Pharmacoeconomics 1997; 11(6):538–549.

  • 234

    Warnock N. Developments in radiology: techniques new, refined and revisited. Iowa Medicine 1993; 83(8):299–301.

  • 235

    Weiss K. The impact of pharmacologic therapy on the costs of asthma. Allergy Proc 1994; 15(4):189–192.

  • 236

    Weiss KB, Sullivan SD. Socio-economic burden of asthma, allergy, and other atopic illnesses. Pediatric Allergy & Immunology 1994; 5(6 Suppl):7–12.

  • 237

    Weiss KB, Sullivan SD. The economic costs of asthma: a review and conceptual model. Pharmacoeconomics 1993; 4(1):14–30.

  • 238

    Weissman IA, Dickinson CZ, Dworkin HJ, O'Neill WW, Juni JE. Cost-effectiveness of myocardial perfusion imaging with SPECT in the emergency department evaluation of patients with unexplained chest pain. Radiology 1996; 199(2):353–357.

  • 239

    West JA. Cost-effective strategies for the management of vascular disease. Vasc Med 1997; 2(1):25–29.

  • 240

    Weston MW. Comparison of costs and charges for fluoroscopic- and echocardiographic- guided endomyocardial biopsy. Am J Cardiol 1994; 74(8):839–840.

  • 241

    Whynes DK, Walker AR, Chamberlain JO, Hardcastle JD. Screening and the costs of treating colorectal cancer. Br J Cancer 1993; 68(5):965–968.

  • 242

    Wilkinson P, Stevenson R, Ranjadayalan K, Marchant B, Roberts R, Timmis AD. Early discharge after acute myocardial infarction: risks and benefits. Br Heart J 1995; 74(1):71–75.

  • 243

    Wilson SR. Individual versus group education: is one better? Patient Educ Couns 1997; 32(1 Suppl):S67–S75.

  • 244

    Windsor RA, Boyd NR. The impact of dissemination of smoking cessation methods on health care costs among pregnant Medicaid recipients. In: Toward the year 2000; 2000:refining-21.

  • 245

    Witmer DR, Dickson-Witmer D, Teixido R. Initial 100 consecutive stereotactic core breast biopsies in a private breast center setting. Del Med J 1997; 69(6):297–301.

  • 246

    Wolff M, Bower DJ, Marbella AM, Casanova JE. US family physicians' experiences with practice guidelines. Family Medicine 1998; 30(2):117–121.

  • 247

    Wong JB, Sonnenberg FA, Salem DN, Pauker SG. Myocardial revascularization for chronic stable angina. Analysis of the role of percutaneous transluminal coronary angioplasty based on data available in 1989. Ann Intern Med 1990; 113(11):852–871.

  • 248

    Wong JG, Feussner JR. Screening for colon cancer. Is it worth the expense? North Carolina Medical Journal 1993; 54(12):634–638.

  • 249

    Woo KS, White HD. Pharmacoeconomic aspects of treatment of acute myocardial infarction with thrombolytic agents. Pharmacoeconomics 1993; 3(3):192–204.

  • 250

    Woods KL, Ketley D. Utilisation of thrombolytic therapy in older patients with myocardial infarction. Drugs Aging 1998; 13(6):435–441.

  • 251

    Wu AH, Clive JM. Impact of CK-MB testing policies on hospital length of stay and laboratory costs for patients with myocardial infarction or chest pain. Clin Chem 1997; 43(2):326–332.

  • 252

    Yen ST, Jones AM. Individual cigarette consumption and addiction: a flexible limited dependent variable approach. Health Economics 1996; 5(2):105–117.

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