Finding a way through the cost and benefit maze

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Abstract
Two months ago the NHS Executive sent its letter “Improving the effectiveness of the NHS” to all district general managers, chief executives of trusts, and family health services authorities (for distribution to general practice fundholders).1,2 Earlier letters had drawn their attention to the NHS research and development programme and existing evidence on clinical effectiveness3 and asked them to purchase less during 1995-6 of two or more procedures known to be ineffective and more of at least two effective ones.4 The most recent letter outlines the close links between this process and the new NHS research and development strategy. In its turn, the requirement to identify effective procedures should focus an intense spotlight on available research findings and have profound implications for future NHS research, especially since effectiveness covers “costs, outcomes, and acceptability to patients and society.”5 It is salutary to examine the degree to which current research findings can provide this information for interventions used after myocardial infarctions. Coronary heart disease is the most …