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Valuing Clinical Strategies Early in Their Development

H. Gilbert Welch, MD, MPH
[+] Article, Author, and Disclosure Information

Grant Support: The author is a Senior Research Associate in the Department of Veterans Affairs Career Development Program—Health Services Research and Development.

Requests for Reprints: H. Gilbert Welch, MD, MPH, Department of Veterans Affairs Hospital, Dartmouth-Hitchcock Medical Center, White River Junction, VT 05009.

Department of Veterans Affairs Hospital
Dartmouth-Hitchcock Medical Center
White River Junction, VT 05009

Ann Intern Med. 1992;116(3):263-264. doi:10.7326/0003-4819-116-3-263
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The unremitting growth of health expenditures has created growing demands on physicians to justify diagnostic and therapeutic strategies. To do so, physicians usually focus on the question of whether treatments can work in the ideal—the question of efficacy (1). Because efficacy is assessed in highly controlled environments, physicians have focused more recently on whether treatments do work under the conditions in which they are applied in practice—the question of effectiveness (2). However, because neither efficacy nor effectiveness measures the resources required to achieve an outcome, physicians have also become interested in the question of cost required to achieve a given


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