Evidence-Based Medicine Meets Cost-effectiveness Analysis

Accumulated public and private frustrations regarding escalating costs and substantial evidence of variation in medical practice have stimulated several parallel movements to narrow the gap between evidence and practice. Beginning with the work of the Canadian Task Force on the Periodic Health Examination1and the US Preventive Services Task Force2and followed by intense interest in the development and dissemination of clinical practice guidelines through a recent movement toward evidence-based medicine,3there has been a proliferation of tools and methods to assess the value of medical interventions and translate those findings into practice. Once the province of a small group of social scientists, meta-analysis, decision sciences, and other methods are now familiar to an expanding cadre of clinician scientists struggling to apply scientific methods to improve routine practice. The opportunities for improvement are immense and fully worthy of the collective effort.4 See also p 285. The