Institute for Health Care Delivery Research
Institute Faculty

Milton C. Weinstein, Ph.D.
Getting Value for Money in Health Care

• Eddy, D. "Cost-Effectiveness Analysis: A Conversation with my Father." JAMA. 1992; 267: 1669-1675
  This article concerns the rationale for cost-effectiveness analysis in health care and serves as background for the discussion that opens the course.
• Mark, D. "Visualizing Cost-Effectiveness Analysis." JAMA.2002; 287: 2428-2429
  This editorial accompanied a recent analysis of optimal management of atypical cervical lesions, and provides a guide to clinicians on how to interpret the findings of cost-effectiveness studies.
• Doubilet, P, Weinstein, MC, and McNeil, BJ. "Uses and Misuses of the Term "Cost Effective" in Medicine." New England Journal of Medicine. 1986; 314: 253-256
  This short paper clarifies the much-abused term "cost-effective" and distinguishes it from "cost-saving" and other related terms.
• Russell, LB, Gold, MR, Siegel, JE, Daniels, N, and Weinstein, MC. "The Role of Cost-Effectiveness Analysis in Health and Medicine." JAMA. 1996; 276: 1172-1177
  This is an overview of the rationale for cost-effectiveness analysis as a guide to resource allocation decisions; the course expands on the concepts introduced here.

• Kim, JJ, Wright, TC, Goldie, SJ. "Cost-Effectiveness of Alternative Triage Strategies for Atypical Squamous Cells of Undetermined Significance. JAMA. 2002; 287: 2382-2390
  Should new technologies to test for infection with the human papillomavirus (HPV) be part of the work-up for cervical cancer screening? (This study influenced the recent guidelines for clinical management of "ASCUS" lesions found in cervical cancer screening.)
• Elkin, EB, Weinstein, MC, Winer, EP, Kuntz, KM, Schnitt, SJ, Weeks, JC. "HER-2 Testing and Trastuzumab Therapy for Metastatic Breast Cancer: A Cost-Effectiveness Analysis. Journal of Clinical Oncology. 2004; 22: 854-863 – PowerPoint
  Trastuzumab (Herceptin) is becoming the standard of care for eligible women with metastatic breast cancer, but what test should be used to identify which women may respond?

• TEXTBOOK: Hunink, M, Glasziou, P, Siegel, J, Weeks, J, Pliskin, J, Elstein, A, and Weinstein M: Decision Analysis in Health and Medicine: Integrating Evidence and Values. Cambridge, UK: Cambridge University Press, 2001.
  This textbook on decision analysis starts at the beginning and gives a comprehensive course in the methods, including computer exercises
• Weinstein, MC, Goldie, SJ, Losina, E, Cohen, CJ, Baxter, JD, Zhang, H, Kimmel, AD, Freedberg, KA. "Genotypic Resistance Testing to Guide the Choice of Therapy in HIV: Clinical Impact and Cost-Effectiveness." Annals of Internal Medicine 2001; 134: 440-450
  Should genotypic antiretroviral resistance testing be done routinely prior to initiation or switching of therapy in AIDS patients? (This study has influenced insurance coverage of HIV resistance testing.)

• Getting Value for Money in Health Care
• Cost-Effectiveness of Alternative Strategies for Equivocal Results on Cervical Cancer Screening Pap Smears
• Decision Analysis: Weighing Risks and Benefits
• Decision Analysis in the Evaluation of Targeted Therapies: The Case of Trastuzumab(Herceptin®)(Journal of Clinical Oncology, 2004)