[Health policy decisions between rationing and rationalization--exemplified by erythropoietin in tumor anemia].

The debate on rationalisation vs. rationing of health care interventions is of great importance for the shaping of social and health care policies. Nevertheless, concrete evaluations mostly deal with health interventions in the grey zone between rationing--withholding effective measures--and rationalisation--avoiding ineffective interventions. The assessment of erythropoietin in tumour anaemia is presented as an example: the results of the treatment of tumour-induced anaemia with EPO are partly unsatisfactory. Only 50-60% of anemic tumor-patients respond to EPO; of these responders 20-30% still require transfusions. The assessment presents the evidence for an "appropriate" application of erythropoietin in tumour anaemia and proposes standard values for a limited access and use of EPO. Additionally the assessment reveals what is known as the benefit of this treatment, and what is questionable. Applying the results of the assessment to clinical practice can be considered as "explicit rationing" according to effectiveness criteria.