High-cost, high-tech medicine: are we getting our money's worth?

Increasingly stringent fiscal restraints on the spending for health care, driven by the scarcity of health resources, has introduced a need to apply cost containment measures to nearly all aspects of medical care. Intelligent cost containment measures must include application of disciplined logic to the decision making process of when to use high-tech, high-cost interventions. Such decision making depends upon knowledge of the basic concepts of economic and cost-benefit analyses, outcome (benefit) studies, and some principles of decision-threshold analysis. These basic principles are reviewed, and the potential impact of application of strategies for cost containment in the operating room and the intensive care unit is discussed.