Health services research clinical trials: issues in the evaluation of economic costs and benefits.

The costs and benefits of treatment interventions are difficult both to conceptualize and to measure. This paper discusses methodologic issues that arise in measuring costs, distinguishing between social costs and transfer payments, measuring the value of life and limb, and assessing the meaning of cost differences. Long-run vs. short-run costs and average vs. marginal costs are considered. Sensitivity analysis to assess the robustness of results to alternative assumptions is stressed. Cost-benefit and cost-effectiveness analyses are seen as important in assessing the policy implications of clinical trials; a proper cost-benefit analysis allows the reader to understand how results relate to the assumptions made in the analyses.