Can it work? Does it work? Is it worth it?

BMJ 1999;319:652-653 ( 11 September )

Editorials

Can it work? Does it work? Is it worth it?

The testing of healthcare interventions is evolving

General practice p 676

The first 150 words of the full text of this article appear below.

The British pioneer clinical epidemiologist Archie Cochrane defined three concepts related to testing healthcare interventions.¹Efficacy is the extent to which an intervention does more goodthan harm under ideal circumstances ("Can it work?"). Effectivenessassesses whether an intervention does more good than harm whenprovided under usual circumstances of healthcare practice ("Doesit work in practice?"). Efficiency measures the effect of an interventionin relation to the resources it consumes ("Is it worth it?").Trials of efficacy and effectiveness have also been describedas explanatory and management trials, respectively,² and efficiencytrials are more often called cost effectiveness or cost benefitstudies.

Almost all clinical trials assess efficacy. Such trials typically select patients who are carefully diagnosed; are at highestrisk of adverse outcomes from the disease in question; lack otherserious illnesses; and are most likely to follow and respond tothe treatment of interest. This treatment will . . . [Full text of this article]

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