In this classic 1996 article, Porter argues that operational effectiveness, although necessary to superior performance, is not sufficient, because its techniques are easy to imitate.
However, the lack of evidence on effectiveness makes it necessary to be careful with recommendations.
Effectiveness is meant to be a more pragmatic measure that addresses the utility of a drug as it is actually employed in practice, therefore to measure effectiveness it is necessary to mirror a real-world environment as much as possible.
Further comparative effectiveness studies are necessary to evaluate the benefits of switching to a different non-TNF biologic versus anti-TNF intraclass switching among patients with an inadequate response to an anti-TNF.
Second, given this somewhat unfortunate current state of the literature, what to do when in a meta-analysis, the combinations of parameters of effectiveness that are necessary to draw conclusions are not present in the literature?
To provide greater health benefits under limited health expenditures based on the results of cost-effectiveness analyses, it is necessary to confirm the effectiveness of medications through well-designed clinical trials having mortality as the primary end point.
This is essential for assessment of cost-effectiveness of interventions necessary to allow just allocation of resources within the National Health Service.
We found that in reviewing evidence of cost-effectiveness it was necessary to try to find common units of benefit with which to compare across a whole range of health improvement interventions.
If three-monthly monitoring turns out to result in a better regulation of diabetes, a cost-effectiveness analysis is necessary to estimate whether the higher costs of three-monthly follow-up balance the better patient outcomes.
The concept of the ICER puts in place a threshold for cost-effectiveness, which is necessary to ensure that adequate health gains can be obtained within the fixed budget of a health care system. 1, 8 For new technologies to effectively bypass this system by being accepted with higher ICERs, it can be assumed that there are additional criteria in place.
