Health care technology: how can we tell if we can afford it? A Canadian viewpoint.

Major changes are reshaping the economic, political, and social climate in which Canada's health care systems operate. Cost containment has become an essential element of that climate. The perception is that health care technology is a major contributor to health care costs, and this has served as the impetus for a call for assessment and evaluation of all health care technology. While the need for health technology assessment is valid, such assessments must be much broader than simple economic assessments. A complete cost-benefit analysis of the clinical use of a given technology, including consideration of possible alternatives and the implications of rejection of that technology in certain circumstances, is complex. If we are to utilize the results of these analyses to effect important changes in health care delivery, studies must include the science behind the technology, the technology itself, the devices resulting from the technology, the medical outcome, and the societal impact in addition to pure cost considerations. Only then will we be able to properly assess the effectiveness and efficiency of health care technology in society and decide whether we can afford it.