VALUING CLINICAL STRATEGIES EARLY IN THEIR DEVELOPMENT

In a society faced with many competing needs and desires there is a strong motivation to assess the value of new clinical strategies. Gulati and Bennett provide a useful template for such evaluation in this issue of Annals. Their study of granulocyte-macrophage colony-stimulating factor measured resource use and efficacy simultaneously. Three factors, however, can make early assessments of value misleading as clinical strategies mature and the conditions in which they are applied change. First, early favorable evaluations of efficacy may appear less promising after widespread dissemination. Second, uncertainty exists regarding the eventual costs of a new strategy. Third, clinicians tend to extend a "cost-effective" strategy well beyond the clinical setting in which it is tested. Such concerns should prompt investigators to complement early assessments of value with assessments made after dissemination.