The techniques of cost-benefit, cost-effectiveness, and clinical-decision analyses provide theoretical frameworks for systematic evaluation of the consequences of medical care programs or policies. For a specific medical problem, these techniques help evaluate the attainment of the "greatest social good," given the limited availability of health resources.1 The analyses, in and of themselves, are limited by the difficulty in determination of values concerning quality-of-life issues and by the model's inability to incorporate political and medicolegal concerns and clinical reality.2 Thus, these tools are usually intended, from a societal perspective, to complement and enhance, not replace, health policy decision making and clinical judgment.3 For complex issues, these analytic tools can help clarify points of agreement and disagreement regarding assumptions, probabilities, values, and what additional information is needed from future studies.4
In this issue of The Journal, Binkin et al,5 by using decision analysis in combination with cost-effectiveness analysis,