Adding to Don's suggestion regarding the question asked, I would also
recommend the following landmark article by Dr. Barbara McNeil and
colleagues:

N Engl J Med  1975 Jul 31;293(5):211-5

Primer on certain elements of medical decision making.

McNeil BJ, Keller E, Adelstein SJ.

The value of a diagnostic test lies in its ability to detect patients with
disease (its sensitivity) and to exclude patients without disease (its
specificity). For tests with binary outcomes, these measures are fixed. For
tests with a continuous scale of values, various cutoff points can be
selected
to adjust the sensitivity and specificity of the test to conform with the
physician's goals. Principles of statistical decision theory and
information
theory suggest technics for objectively determining these cutoff points,
depending upon whether the physician is concerned with health costs, with
financial costs, or with the information content of the test.

Chris

Chris L. Pashos, PhD
Vice President and Executive Director of HERQuLES
Health Economic Research and Quality of Life Evaluation Services
Abt Associates Clinical Trials
55 Wheeler Street
Cambridge, MA 02138 USA
Tel 1 617 520 2935
Fax 1 617 868 2221
[log in to unmask]




Dear colleagues,

My colleague, Dominic Hodgkin, suggested that a brief "primer" on
cost-effectiveness might be useful for this purpose.  Although I wrote the
paper over 20 year ago, I have continued to use it in introductory
lectures.

The citation is:
Shepard, D.S. and Thompson, M.S. First principles of cost-effectiveness
analysis in health. Public Health Reports 94(6):535-543, 1979.

As this journal was published by the US government, articles may be copied
free of cost provided the source is acknowledged.  A text version (with a
few formatting problems resulting from scanning) is on my web page under
the
article's title at http://www.sihp.brandeis.edu/shepard/downloads.html

I hope this is helpful.

Donald S. Shepard, Ph.D.
Professor, Schneider Institute for Health Policy
Heller School for Social Policy and Management, Room G19, MS 035
Brandeis University
Waltham, MA 02454-9110 USA
Tel: 781-736-3975    Fax: 781-736-3928
E-mail: [log in to unmask]  web: http://www.sihp.brandeis.edu/shepard

-----Original Message-----
From: The international health economics discussion list.
[mailto:[log in to unmask]]On Behalf Of Ruth McDonald
Sent: Wednesday, February 05, 2003 8:16 AM
To: [log in to unmask]
Subject: Economics & Screening


Can anybody recommend an accessible text (or texts ) on
economic principles & screening? My local Primary Care Trust
is trying to inform its community health workers on the subject &
make clear that there are costs as well as benefits to screening &
that cost-effectiveness, not just effectiveness, should be
considered too. If you can recommend anything generic (as
opposed to specific CEAs of screening technologies or
processes) that we could use as part of an educational input then
please get in touch.
Many thanks
Ruth McDonald

Ruth McDonald
Department of Applied Social Science
University of Manchester
Williamson Building
Oxford Road
Manchester
M13 9PL
Phone 0161 275 4912
Fax 0161 275 4724