Booklet of Abstracts - Institut für Weltwirtschaft

ESF Research Conferences
A Programme of the European Science Foundation
Booklet of
Abstracts
With support from
Fritz Thyssen Stiftung für
Wissenschaftsförderung
Institut für Weltwirtschaft an der Universität Kiel
ESF-IfW Conference on The Global Health
Economy
New Technology and Medical Decision
Making
Normative Models and Empirical Practice
Salzau Castle (near Kiel) � Germany � 4 - 9 October 2006
Chair: Uwe Siebert � UMIT, Hall, AT & Harvard Medical School,
Boston, US
Co-Chair: Peter Zweifel � University of Zürich, CH
www.esf.org/conferences/sc06219
State Government of
Schleswig-Holstein

Welcome Address
by Dr. Gitta Trauernicht
Dear Ladies and Gentlemen,
to locate your conference “New Technologies and Medical Decision Making: Normative
Models and Empirical Practice” in Schleswig-Holstein was a wise decision. Not only because
our state has a lot to offer, and Salzau Castle is a superb conference site, but primarily
because Schleswig-Holstein has successfully positioned itself as a national and international
centre of excellence in health care and a variety of health-related industries. With innovative
products and praxis oriented research Schleswig-Holstein is leading in many areas of the life
sciences.
Internationally renowned companies in medical technology with special strengths in precision
surgery, implantology and anaesthesiology are at the heart of Schleswig-Holstein’s
achievement. The biotechnology industry has also taken root with considerable success here
in the north. Universities and industry are working hand in hand in the search of new
chemical substances for the pharmaceutical industry, improved diagnostic devices, and
promising new therapies for life-threatening diseases.
In Schleswig-Holstein, numerous private companies, university-based researchers, and
hospital clinicians are working closely together on new medical products and methods for the
welfare of patients. New standards in research and science are sent by the FUSION project
at the Lübeck campus of Schleswig-Holstein’s University Hospital, where new procedures for
gentle liver surgery are being tested, and by the cluster of excellence “Inflammation at
Interfaces” at the University of Kiel, which investigates the role of inflammable processes and
diseases in the human body. Another example of excellence is provided by the Fraunhofer
task group “Cellular Differentiation and Cellular Technology” at the University of Lübeck,
which is concerned with the isolation and characterization of adult stem cells.
Schleswig-Holstein’s University Hospital is the second biggest university hospital in
Germany. A variety of internationally renowned science and research facilities, such as the
Leibniz Research Centre for Biomedicine at Borstel and specialized hospitals all over
Schleswig-Holstein, help to push the frontier of medical knowledge outward.
Our state has recognised very early the enormous opportunities in the growing health care
market of the future. To capitalize on these opportunities, we founded a strategic advisory
council with members from industry, academia and politics, known as “Gesundheitsinitiative
Schleswig-Holstein”. In a joint effort with delegates from physicians’ associations, hospitals,
health insurers and other companies in the health care industry, from research centres,
chambers of industry and professional associations, we aim to systematically expand
Schleswig-Holstein’s competencies and to enhance the quality of health care made in

Schleswig-Holstein. Close cooperation between the provision of health care and healthrelated
industry has long been a defining characteristic and continues to strengthen our
profile as a health care state.
The conference organized by the Kiel Institute for the World Economy and the European
Science Foundation fits perfectly in the context of our state, and we are therefore happy to
support it with financial resources from the Gesundheitsinitiative.
I wish you a successful conference.
Dr. Gitta Trauernicht
Minister for Social Welfare, Health, Family, Youth and Seniors in the state of Schleswig-
Holstein.

Begum, House Ara
University of Dhaka, Institute of Health Economics
Khalabhaban, 1000 Dhaka, Bangladesh
Telephone: +0044 02 901 4925
Email: hab31@cam.ac.uk
The Impact of Food Supplementation on Infant Weight Gain in Rural Bangladesh; an
Assessment of the Bangladesh Integrated Nutritional Program (BINP)
Housne Ara Begum1*, CGN Mascie-Taylor2
1 Institute of Health Economics, University of Dhaka, Dhaka, Bangladesh; 2 Department of Biological
Anthropology, University of Cambridge, UK
Objective: To examine the efficiency of the Bangladesh Integrated Nutritional Program (BINP) in
identifying infants to be supplemented, effectiveness in administration of supplementation over entire
stipulated period of time, and the correctness of exit criteria from the supplementation program that
were used. Furthermore the study investigated whether targeted food supplementation of infants
between 6-12 months of age resulted in enhanced weight gain.
Setting: Mallickbari Union, Bhaluka, a rural area located about 100 kms north of Dhaka, Bangladesh.
Participants: 526 infants followed for 6 to 12 months.
Results: Of the 526 infants studied, 368 should have received supplementation based on BINP
criteria, but only 111 infants (30%) did so, while a further 13% were incorrectly given supplementation.
So in total over half (52.8%) of the sample were incorrectly identified for supplementation. In addition
less than a quarter of the infants received the full 90 days of supplementation and close to half the
infants exited the program without the requisite weight gain. Infants were assigned to one of four
groups; correctly supplemented and correctly non-supplemented, incorrectly supplemented and
incorrectly non-supplemented. This classification provided natural controls; the correctly supplemented
infants vs the incorrectly non-supplemented infants, and the correctly non-supplemented infants vs the
incorrectly supplemented infants. There were no significant differences in weight gain between the
correctly supplemented group and the incorrectly non-supplemented group or between the correctly
non-supplemented and the incorrectly supplemented groups nor was any evidence of growth faltering
in the incorrectly non-supplemented group.
Conclusions: This study found serious programmatic deficiencies - inability to identify growth faltering
infants, failure to supplement for the full time period and incorrect exit procedures. There was no
evidence that food supplementation had any impact on improving infant weight gain.

Bischof, Matthias
University of Basel, Institute for Clinical Epidemiology and Swiss Tropical Institute
Hebelstr. 10, 4031 Basel, Switzerland
Telephone: +41 764 399 518,
Email: m.bischof@stud.unibas.ch
Expected Value of Perfect Information for Osteoporosis Cost-utility Analysis. Would it
Pay off to Know More?
Introduction: Osteoporosis is a major public health concern. Effective interventions are available for
the prevention and treatment of osteoporosis. There are several economic evaluations that examine
the cost-effectiveness of these interventions. Although some of these analyses include probabilistic
sensitivity analysis (PSA) to incorporate parameter uncertainty into the model, none of the models has
been used to describe the amount of uncertainty in monetary terms. This is done in this study by the
calculation of the expected value of perfect information (EVPI) for all parameters in the osteoporosis
model and for four groups of parameters individually.
Methods: A probabilistic Markov model was used in a cost-utility analysis performed from a Swiss
health care perspective to analyse the cost-effectiveness of the bisphosphonate risedronate and
calcium and vitamin D compared to calcium and vitamin D alone. Probability distributions were fitted to
all parameters that could in principle be sampled. Lognormal distributions were used for the treatment
effect, beta distributions were used for the probability and quality of life parameters and parameter
uncertainty in cost parameters was represented by gamma distributions. PSA was performed with
5’000 Monte carlo simulations.
Results: Risedronate is both more effective and costly than no treatment, resulting in an incremental
cost-effectiveness ratio (ICER) of CHF 110'982/QALY. The incremental net monetary benefit (INMB)
at lambda CHF 80’000/QALY is CHF -7.6m for 10'000 women beginning with a 5-year treatment at
age 70. At lambda CHF 80’000/QALY risedronate has a 33% probability of being cost-effective. Total
EVPI is CHF 9.5m per 10'000 treated patients when using the same willingness to pay. The
parameters of the treatment effect contribute the most to the decision uncertainty with an EVPI of
more than CHF 7m. Quality of life parameters also have a substantial impact on total parameter
uncertainty. Other transition probabilities and costs have a much smaller impact on the decision
uncertainty.
Discussion: Even with probabilistic decision models, a decision for or against the adoption of a new
treatment is still based on the expected value of the ICER or the INMB. PSA allows to calculate the
probability that a treatment is cost-effective. As most decision models will incorporate a fair amount of
parameter uncertainty, a decision maker will face the possibility of making a wrong decision. EVPI
calculations allow to identify those parameters that contribute the most to overall decision uncertainty.
Based on the results of the EVPI it might be reasonable and cost-effective to demand further
information for certain parameters before deciding for or against a new.

Bleichrodt, Han
Erasmus University, Faculty of Economics, Department of Applied Economics
P.O. Box 1738, 3000DR Rotterdam, Netherlands
Telephone: +31 10 408 1295, Telefax: +31 10 408 9141
Email: bleichrodt@bmg.eur.nl
The Optimal Management of Comorbidities and Related Risks
We show that the willingness to pay for health improvements increases with the severity and
probability of occurrence of comorbidities. This result, which is obtained under mild restrictions on the
shape of the utility function, has important implications for cost benefit studies applied to health care.
In particular it implies that the discrimination of the elderly, believed to be implicit in cost benefit
analysis, is less of a problem than commonly thought.
Based on a paper that appeared in Journal of Public Economics 87 (2003) 2399-2406 under the title
“Comorbidities and the willingness to pay for health improvements,” by Han Bleichrodt, David Crainich, Louis
Eeckhouldt.

Bosch, Johanna L.
Erasmus Medical Centre, Dept. Of Epidemiology and Biostatistics, ART group, Room Ee21-40b
Dr. Molewaterplein 40, 3015 GD Rotterdam, Netherlands
Telephone: +31 10 408 8214, Telefax: +31 10 408 9382
Email: j.l.bosch@erasmusmc.nl
Assessing Technologies for the Treatment of Cardiovascular Disease
In the last decades, probably the most innovative and revolutionary technology for the treatment of
cardiovascular disease has been endovascular stenting. In 1964, Charles Dotter was the first who
introduced the radiological interventional technique balloon angioplasty. It was not until the late
eighties, however, that the stent was introduced and increasingly applied. The vascular stent is a small
metallic device that can be used to keep a blood vessel open; it is a minimally invasive technique that
is currently performed by various disciplines, that is, by interventional radiologists, vascular surgeons,
cardiologists, and neurologists. Over the past 10 years, the stent technology has been developed
dramatically, from bare-metal stents to drug-eluting stents and it is now being applied in all main
arteries of the vascular system, in the carotid arteries, coronary arteries, abdominal aorta, and
peripheral arteries. Because of its’ minimally invasiveness physicians are often eager to use
endovascular stents, as stenting often results in lower mortality and morbidity rates compared to an
open procedure. In the long-term, however, after stenting extensive surveillance is needed and
additional interventions are frequently performed. Therefore, short- and long-term outcomes and
associated costs should be assessed adequately. In my presentation today, I will present an overview
of the major studies performed to assess endovascular stenting for the treatment of cardiovascular
disease.

Bridges, John F.P.
Assistant Professor, Department of Health Policy & Management, Johns Hopkins Bloomberg School of
Public Health
624 N. Broadway, Rm 451, Baltimore, MD. 21205, United States
Telephone: +1 410-614 9851, Telefax: +1 410-614-9152
Email: jbridges@jhsph.edu
The Impact of Health Technology Assessments on the Timing of Market Access and
Technology Adoption
Health Technology Assessment is a growing phenomenon worldwide. While it relates, in part, to the
work of government designated “fourth hurdle agencies,” HTA as a movement is much broader and
involves a diverse range of stakeholders. That said, there are those who aim to monopolize the HTA
agenda, often preaching stories of scarce resources and the need for cost effectiveness in national
health care system. Others aim to (mis)use HTA to slow the uptake of costly innovations, particularly
pharmaceuticals. There is a growing movement to reconsider the role of HTA to ensure that it better
promotes innovation and is more responsive to the needs of patients. In many ways these two issues
are different sides as of the same coin – innovations must be evaluated though the patients’ eyes and
patients preferences need to inform the development of innovations.
These new movements in HTA pose a significant challenge to the status quo. However, a number of
governments around the world are now attempting to modify their health care system, from one that is
obsessed with the perceived crises of today, towards one where innovation in health care is promoted
with the understanding that it is a longer-term and uncertain endeavor. While most developed
countries have developed policies relating to becoming knowledge economies, often citing health care
as a specific agenda, they must start to change their policies towards the timing of market access and
technology adoption if they aim to produce innovations in health care at all. Emerging issues like the
globalization of health care markets and the movement towards personalized medicines reinforce the
need to embrace technology adoption if countries are going to have competitive health care systems
and, more importantly and more generally, competitive economies.

Briggs, Andrew
University of Glasgow, Department of Public Health & Health Policy
1 Lilybank Gardens, G12 8rZ Glasgow, United Kingdom
Email: a.briggs@clinmed.gla.ac.uk
Statistical Modelling of Clinical Trial Data for Economic Appraisal: An Alternative to
the Standard Approach?
Purpose: To explore an alternative method of analysing and presenting trial-based economic
appraisals.
Methods: A recent ISPOR task force has set out guidance for conducting economic appraisals
alongside clinical trials. The guidance reinforces what has become an accepted ‘standard’ of
analysing the results of trial-based economic appraisal. An alternative approach to analysing
economic data collected alongside clinical trials is explored based on statistical relationships in the
data. This approach is contrasted with the standard methods using a recently published example.
Results: The standard approach to economic analysis yields cost-effectiveness point estimates that
appear to be highly cost-effective (less than £10,000/QALY). However, considerable uncertainty is
evident with confidence intervals overlapping £30,000 per QALY. By contrast, the statisical modelling
approach yields slightly less favourable point estimates, reflecting the cautious approach to the
analysis. Nevertheless, the estimated statistical uncertainty is less and yields confidence intervals that
have upper limits below £30,000/QALY.
Conclusions: Standard approaches to the analysis of economic data alongside clinical trials tend to
yield cost-effectiveness estimates that are highly uncertain due to the typical underpowering of trials in
relation to secondary outcomes such as cost and quality of life. More formal statistical modelling of
economic data may offer increased power and reduced uncertainty subject to the validity of the
underlying assumptions. On the basis of the single example presented here we can only conclude
that there may be potential merit in adopting such an approach – particularly when the validity of the
randomised comparison on the primary clinical outcome is retained.

Brixner, Diana I.
University of Utah, Associate Professor and Chair, Department of Pharmacotherapy, Executive
Director Pharmacotherapy Outcomes Research Center, President Elect International Society of
Pharmacoeconomics and Outcomes Research 2006-2007
30 South 2000 East, Salt Lake City, UT 84112, United States
Telephone: +1 801 581-3182, Telefax +1 801 585-6160
Email: dbrixner@hsc.utah.edu
Real World Data Methods: Use of Real World Data in Outcomes Research
'Real world' data is defined as information (data) collected beyond that which is normally collected in
Phase III clinical trials that focus on efficacy. This presentation will address the issues and framework
for analysis of 'real world' data in outcomes research as described in the ISPOR Task Force Report on
Use on Real World Data in Coverage and Reimbursement Decisions. The types of real world data
(piggy-back information from Phase III clinical trials, large simple trials, registries, administrative claims
databases, electronic medical records) and benefits and challenges of these data, as well as evidence
hierarchies and their usefulness will be discussed. Examples of the use of real world data for different
types of outcomes (clinical outcomes, economic outcomes, and quality of life / patient-reported
outcomes) will be presented. Health care payer and decision maker perspectives will also be
addressed.

Carlsson, Per
National Centre for Priority Setting in Health Care
Landstinget I Östergötland, 58191 Linköping, Sweden
Telephone: +46 132 249 92, Telefax: +46 132 249 95
Email: per.carlsson@his.liu.se
National Guidelines for Heart Diseases- A Model for Open Priority Setting in Sweden
Per Carlsson, Lars-Åke Levin
National Center for Priority Setting and Center for Medical Technology Assessment
Background: The National Board for Health and Welfare initiated year 2000 an extensive and
progressive program on priority setting in Sweden. The aim is to produce evidence based guidelines
with additional explicit priorities for major diseases. The underlying idea is to support relative
autonomous health care providers with adequate information for local policy making and clinical
decision making. A preliminary work was published in 2001 on coronary heart diseases. The first
regular version of guidelines for heart diseases was published in June 2004 and the second version is
now underway and is planned to be published in the beginning of next year. Parallel similar work is
ongoing in several other medical fields e.g. cancer diseases.
Method: A model for vertical priority setting was developed in order to integrate medical, health
economic evidences and to make value judgements. The work model has been revised several times.
The implementation of the guidelines is studied in four regions/county councils by interviews and by
using registry data.
Results: To set up a national system for open priority setting is challenging. The experiences from this
Swedish program is however promising. It is clear that the guidelines is accepted by a majority among
professional groups but still is the administrative/political group of actors uncertain about how to use
this information in their decision making.
Conclusion: Sweden has an established system and long tradition of HTA. Still, there are few good
examples that show that HTA has been used in a systematic way in policy making. We believe
Sweden is in the middle of a breakthrough concerning the integration of HTA and priority setting.

Carrera, Percivil M.
University of Heidelberg, Medical School, Department of Tropical Hygiene and Public Health, Junior
Group International Health Economics and Outcome Research
Im Neuenheimer Feld 365, Raum 003, 69120 Heidelberg, Germany
Telephone: +49 6221 56 6819, Telefax: +49 6221 56 6823
Email: percivil.carrera@urz.uni-heidelberg.de
Post-unification Health Reforms in Germany: The Evolutionary Approach to Reforms
and Its Impact on Innovation
Since unification and against the backdrop of economic downturn and changing demographics, the
German social health insurance (SHI) system was subjected to barrage of reform measures aimed at
containing spending and increase cost-efficiency. Although most of the reform measures concentrated
on reimbursement and financing, reforms were also pursued in the organization and delivery of care in
Germany.
This paper reviews health reforms in Germany and assesses their nature based on a scale that maps
the fidelity of reform measures on the founding principles of subsidarity and solidarity. Based on these,
this paper at the same time, comments on how innovation fared under such reforms.
The analysis shows that the 14 types of reforms over the past 15 years in general shifted away from
the status quo and took the evolutionary route. Unfortunately, the modest results of the reforms and
remaining deficiencies of the SHI system leave a lot to be desired with the evolutionary approach to
reforms. This is highlighted by the underlying views that on the one hand, innovation is a cost-driver
and mechanistically activated while on the other hand, it is potentially a disruptive force to the powerstructure.
Acknowledgment: This paper is based on Carrera P, Kinder Siemens K and Bridges JFP. 2006. “Mapping Post-
Unification Reforms in the German Social Health Insurance System – Is it now time for the revolution?” Under
review.

Claxton, Karl
Assistant Professor of Health and Decision Sciences, Harvard School of Public Health; Senior
Lecturer in the Department of Economics and Related Studies at the University of York; Member,
National Institute for Health and Clinical Excellence Appraisal Committee
Centre for Health Economics, Alcuin 'A' Block, University of York
Heslington, YORK, YO10 5DD, United Kingdom
Telephone: Tel: +44 (0)1904 321401, Telefax: +44 (0)1904 321402
E-Mail: kpc1@york.ac.uk
Using Value of Information Analysis to Prioritise Health Research: Some Lessons from
Recent UK Experience
Decisions to adopt, reimburse or issue guidance on the use of health technologies are increasingly
being informed by explicit cost-effectiveness analyses of the alternative interventions. Health care
systems also invest heavily in research and development to support these decisions. However, the
increasing transparency of adoption and reimbursement decisions, based on formal analysis, contrast
sharply with the decisions about research priorities and commissioning. This, despite the fact that
formal measures of the value of evidence generated by research are readily available. In this paper,
the principles of value of information analysis are briefly outlined before discussing the results of two
recent opportunities to apply these methods directly to inform policy decisions about research priorities
in the UK. These include a pilot study for the UK National Co-ordinating Centre for Health Technology
Assessment (NCCHTA) and a pilot study for the National Institute for Health and Clinical Excellence
(NICE). The implications of the results of the pilots for research priorities and the type of research
needed are explored. Some of the methodological and policy challenges are discussed.

Detmer, Don E.
University of Virginia, Charlottesville; President/CEO, American Medical Informatics Association
4915 St. Elmo Ave, Suite 401 Bethesda, MD 20814, United States
Telephone: +1 301 657 12 91, Telefax: +1 301 657 1296
Email: ded2x@virginia.edu
The Information Structure for Effective Evidence-based Medical Decision Making
Effective evidence-based medical decision-making (EMD) is a global requirement for biomedical
research, knowledge discovery, and healthcare. A robust infrastructure is needed to shift from paper to
computable language along the entire EMD ‘food chain’. This will require an amalgam of computerbased
standards and repositories plus organizational structures to assure appropriate changes over
time, including system maintenance. Fine grained standards relating to terminology, data structures,
and disease classifications within a global framework will link new discoveries including treatments to
practice environments to assure safety and efficiency via continual updates to decision support
systems in computer-based health records.
Three key pillars for EMD in healthcare delivery include assuring that the best knowledge is available
when and where it is needed, high adoption and effective use, and continuous improvement of EMD
methods and the knowledge base itself. Structure must deal with guidelines and decision-support
applications for electronic health record linking informaticians with medical specialty professional
associations and governmental entities. Working models and initiatives supporting key dimensions of
the concepts described above are underway and well developed in some domains but the efforts are
not integrated internationally into a comprehensive strategy. Further, it is not yet clear what
organizational model or entity(s) would be most effective for global support of EMD.

Diez, Francisco Javier
UNED, Universidad Nacional de Educación a Distancia, ETSI Informatica, Research Center on
Intelligent Decision-Support Systems
c/ Juan del Rosal, 16, 28040 Madrid, Spain
Telephone: +34 646 794 342, Telefax: +34 913 988 895
Email: fjdiez@dia.uned.es
Probabilistic Graphical Models for Medical Decision Making
Francisco Javier Díez and Manuel Luque, Research Center in Intelligent Decision-Support Systems, UNED,
Madrid, Spain
A probabilistic graphical model (PGM) consist of a join probability distribution and a graph that, roughly
speaking, represents the conditional dependencies and independencies of the distribution. Some of
the PGMs more widely used for solving real-world problems are Bayesian networks, influence
diagrams and factored Markov decision processes.
Bayesian networks (BNs) are a powerful method for diagnosis, which, in contrast with the traditional
probabilistic method, known as naïve Bayes, do not require that the diagnoses are mutually exclusive
nor that findings are conditionally independent. Additional advantages of BNs are that they can
represent causal knowledge, can be learnt from databases, can easily combine knowledge from
different sources (objective data, subjective estimates, etc.), and can explain the reasoning, i.e., why
the system has arrived at a certain conclusion. BNs are also used in epidemiology, under the name of
“causal DAGs”, to detect and quantify causal influences.
Influence diagrams (IDs), in turn, were developed as decision-analytic models that offer important
advantages with respect to the “traditional” method —namely, decision trees— especially in medicine,
such as the explicit representation of causal dependencies and independencies, the use of direct
probabilities, and the possibility of using canonical probabilistic models (noisy OR, noisy MAX, etc.)
and super-value nodes. These advantages facilitate the construction, debugging and extension of the
models, and simplify the conduction of sensitivity analyses and cost-effectiveness analyses.
Additionally, there are specific algorithms for evaluating IDs, which are in general much more efficient
than expanding and rolling-back the equivalent decision tree. IDs can also be applied to the
elaboration of clinical practice guidelines (CPGs), thus offering the possibility of quantitatively
combining several sources of evidence, adapting them to different scenarios (a certain subpopulation,
other country, etc.) and including patient-specific utilities. However, standard IDs also present
significant limitations, which may partially explain why, in spite of their advantages, they are still
unknown and rarely used in medical studies. These are mainly the difficulties for representing
asymmetric decision problems, in particular those with unordered decisions, and the scarcity of
software packages able to perform sensitivity analysis and cost-effectiveness analysis directly on IDs.
Markov models, such as Markov chains and Markov decision processes (MDPs), have also been used
to represent medical problems. The latter can be either fully observable (FOMDPs) or partially
observable (POMDPs). Factored MDPs, which factorize the probability in accordance with a graph,
are a particular type of PGM.
In this talk we will briefly mention some of the results of our research on PGMs applied to medicine,
such as the following:
1. decision analysis networks (DANs), a new model for asymmetric decision problems that
admits unordered decisions, thus overcoming the main limitation of standard IDs;
2. dynamic limited-memory influence diagrams (DLIMIDs), a model for representing
Markovian processes, much more flexible than standard POMPDs;
3. Elvira, a public-software tool for building and evaluating BNs and IDs, which has been
developed as a collaborative project of several Spanish universities; it offers sensitivity
analysis for IDs and will soon offer cost-effectiveness analysis;
4. some models that we have built for medical domains, such as cardiology, liver diseases
and several types of cancer.
In summary, in this talk we advocate for the use of PGMs in medicine and public health, and offer our
collaboration to research groups interested in applying PGMs in their investigations.

Dintsios, Charalabos-Markos
Institute for Quality and Efficiency in Health Care associated with Hannover Medical Department of
Epidemiology, Social Medicine & Health Systems Research
Theodor-Heuss-Ring 12, 50668 Köln, Germany
Telephone: +49 2213 568 5261, Telefax: +49 221 3568 5858
Email: charalabos-markos.dintsios@iqwig.de
Innovation-related Health Technology Assessment of Cardiovascular Implants
Pre-market Evaluation of Innovative Technologies Considering as Example Valved
Venous Conduits
Dintsios Ch.-M., Krauth C., Hagen A., Gerhardus A., Schwartz F.W.
Background: Pre-market evaluation takes into consideration the safety, effectiveness and cost-benefit
ratio of innovative technology including legal, social and ethical issues. Assessments of technology
prototypes are faced with the dilemma of reaching convincing results without any available technology
to compare with.
Target: Main objective of the evaluation of valved venous conduits within the competence-network
Cardiovascular Implants is the prognosis of need-dependent provision of medical care and potential
development paths of a curative therapy option based on tissue-engineering for the treatment of
chronic venous insufficiency due to postthrombotic syndrome from a societal perspective.
Methods: Using scenario-technique, an explorative prognostic procedure to disclose uncertainty taking
into account environment conditions simultaneously, the technology potential of providing medical care
under German health system conditions after the diffusion of technology over a period of five years will
be shown, possible disruptive factors together with their negative repercussions identified and
consequences of possible development variation analyzed.
Results: Scenario-technique provides a spectrum of possible incident sequences in a sort of trend
scenarios and extreme scenarios of care potential of the innovative technology. Until now there were
identified 71 impact factors out of 20 fields of the internal project area and the global environment,
from these 19 essential factors were ascertained through cross-linking matrices, a consistency
analysis of their diverse values was performed, crossimpacts to describe the mutual interdependence
were computed and finally 20827 possible scenarios were generated. The most consistent of them
illustrate extreme, the most probable constitute the trend scenarios.
Discussion: socio-economic pre-market evaluation of expensive innovative medical technologies
achieves in times of insufficient resource allocation within health systems eminent importance. It’s a
moot question whether the introduced evaluation approach and method is proper for a proactive
evaluation and respective regulation of innovative cardiovascular technologies or not.
Conclusion: The explored scenarios point out a spectrum of possible incident-sequences without
determining them. The gained findings shall be put at the disposal of policy-makers and may enter in
the regulation of innovative technologies.

Eeckhoudt, Louis
FUCAM, Facultes Universitaires Catholiques de Mons, Université Catholique de Lille and Center for
Operations Research and Econometrics at Louvain-la-Neuve
Chaussée de Binche, 151; 7000 Mons, Belgium
Telephone: +32 69 22 89 44
Email: eeckhoudt@fucam.ac.be
Some Recent Developments in “Decision Sciences” and their Implications in Medical
Decision Making
The developments of the “expected utility” model (E.U.) and the definition of such concepts as risk
aversion in the early 60’s have had a deep impact on the “medical decision making” (M.D.M.)
literature. This influence was quite strong from the very first steps of this field of research in the mid
70’s and it remained quite important since then either explicitly or implicitly both for empirical or
theoretical studies.
In the meantime new developments took place in the broad field of decision science. One of them –
the advent of “non E.U.” models (such as rank dependent E.U. or prospect theory) – made its way
very quickly into the M.D.M. literature and it will not be discussed here.
In this presentation I shall instead concentrate on some new developments that took place in the E.U.
model itself and I’ll discuss their potential relevance in the field of health. The contributions I’ll refer to
turn around the notion of “downside risk aversion” introduced by Menezes, Geiss and Tressler in 1980
[1]. After having defined this notion and its extensions through the concepts of “prudence” and
“temperance” ([2]) its relevance will be illustrated for a better understanding of preventive choices.
While the low private demand for prevention is very often explained by the “irrationality” of patients
(e.g. systematic underestimation of the probability of disease or myopia) the notion of downside risk
aversion enables us to understand why prevention is not a naturally attractive activity for rational
decision makers.
References
[1] C. Menezes, C. Geiss and J. Tressler. „Increasing downside risk“. American Economic Review, 1980, 70(5),
921-932.
[2] L. Eeckhoudt and H. Schlesinger, “Putting risk in its proper place”. American Economic Review, 2006, 96(1),
280-289.

Fliedner, Juliane
Albert Ludwigs Universität Freiburg, Institute for Economic Policy Research, Department of
International Economic Policy
Platz der Alten Synagoge 1, 79085 Freiburg, Germany
Telephone: +49 761 203 2346, Telefax: +49 761 203 2414
Email: juliane.fliedner@vwl.uni-freiburg.de
Why is HIV Prevalence Higher for Rich People? Evidence from Kenya
Eva Deuchert and Juliane Fliedner
In 2005, official statistics restate the alarming dimension of HIV/AIDS attacking the African continent.
However HIV/AIDS does not strike uniformly across and within African countries. Empirical evidence
for several African countries suggests that HIV/AIDS prevalence is higher among wealthier people.
This is puzzling as disease and poor health is usually positively associated to poverty. The most
prominent explanation for this HIV-wealth puzzle is that wealthier people face higher HIV infection
rates due to higher risk-taking sexual behaviour. The present paper empirically tests if higher HIV
prevalence among wealthier women and men in Kenya can be attributed to their sexual behaviour. It is
shown that risk-taking behaviour is positively associated with wealth for men and that it increases the
HIV risk for both, men and women. However, for women other wealth-related risk factors that are not
due to sexual behaviour are still unobserved. For men, such unobserved risk factors are educationrelated.
Thus, risk-taking sexual behaviour is not sufficient to assess the HIV-wealth puzzle and
alternative hypotheses need to be analysed.

Gandjour, Afschin
University of Cologne, Department of Health Economics and Clinical Epidemiology
Gleueler Str. 176-8, 50939 Köln, Germany
Email: gandjour@igke.de
Priority Setting of Investments that Enhance the Adoption of Health Technologies
Substantial deficits in the adoption of health technologies exist in essentially all areas of health care
(McGlynn et al., N Engl J Med 2003). That is, evidence-based treatment recommendations are not
adequately implemented in clinical practice resulting in deficits in the quality of care. Prior research
has shown that infinite resources are needed to improve the adoption of health technologies from an
almost perfect to a perfect level (Gandjour and Lauterbach, Med Decis Making 2003). Given scarce
resources, perfect implementation of evidence-based treatment recommendations in clinical practice is
thus an impossible mission. Decision makers need to acknowledge the limited resources for quality
improvement and make trade-offs between investments in different health technologies. Decision
makers also need to acknowledge the limited time available to physicians and educators to participate
in educational activities that enhance the adoption of health technologies. Traditional costeffectiveness
and costbenefit analysis of quality improvement activities do not consider the time
constraint of physicians and educators. A constrained optimization problem exists that needs to be
solved by nonlinear programming. The goal was therefore to develop a mathematical program that
maximizes the benefit of investment into adoption of health technologies while acknowledging the
above constraints. This is the first program that deals with the question of how to allocate resources to
the vast number of quality improvement strategies available. Benefit is measured in terms of health or
utility. Implementation costs are calculated by an integral function (Gandjour and Lauterbach, Med
Decis Making 2005). The program is set up under two scenarios: 1) a budget for quality improvement
or educational activities exists; and 2) no such budget exists, allowing trade-offs between an
investment in i) quality improvement, ii) other measures to improve health, and iii) an increase of
consumption. As the model is only concerned with maximizing benefit (health or utility), concerns
regarding the distribution of benefits in the population are discussed separately. Policymakers, health
insurance companies, managed care organizations, academic medical institutions, and commercial
organizations may use the model for strategic planning.

García-Barbero, Milagos
Head Office, WHO European Office for Integrated Health Care Services
Marc Aureli 22-26, 080006 Barcelona, Spain
Telephone: +34 93 241 8270, Telefax: +34 93 241 8271
Email : mgb@es.euro.who.int
The eHealth Strategy of the WHO: Problems and Prospects
Europe is a vast union of unique and diverse nations. The UN Europe comprises 53 countries with a
variety of cultures, religions, languages, geographical accidents, economical development and sociodemographic
trends. This poses great challenges of and opportunities for the use of technology to
improve information and communication within and across countries and therefore to support health
and population development.
eHealth, used in the broad sense of the term, is considered a tool for improvement of the health
systems. It should not be an aim on itself but an instrument to put the citizen/patient at the center of
the system.
A health system is defined in The World Health Report 2000, to include all actions whose primary
purpose is to promote, restore or maintain health (WHO 2000). The document identifies the following
goals for a health system:
• Improve the health of the population served (health – level and distribution)
• Respond to peoples’ legitimate expectations (responsiveness – level and distribution), and
• Provide financial protection against the cost of ill-health (fair financing)
The health system attains its goals by carrying out a number of functions (that is, groups of similar
activities within the system). From this perspective:
• Services need to be produced (“Service Provision”).
• Funding has to be ensured (“Financing”).
• Inputs have to be “created” (“Resource Generation”).
• The whole system has to be governed (“Stewardship / Regulation”).
eHealth, the combined use in the health sector of electronic communication and information
technology, is a mechanism to support the four functions by facilitating the exchange of information,
connecting services and infrastructure, support capacity building of the professionals and speed up
administration.
The World Health Assembly in May 2005 adopted resolution WHA58.28, inter alia recognizing that a
WHO eHealth strategy could serve as a basis for WHO's activities on eHealth, as well as urging
Member States to consider drawing up long term strategic plans for developing and implementing
eHealth services...., and requesting WHO to provide technical support to Member States, and facilitate
integration of eHealth in health systems and services, including in training.

Gelijns, Annetine C.
Professor of Surgical Science and Public Health, Co-Director, International Center for Health
Outcomes and Innovation Research
600 West168th Street (7th Floor), New York, NY 10032, United States
Telephone: +1 212 305 9100; Telefax: +1 212 305 4256
Email: Acp10@columbia.edu
The Dynamics of Technological Change
Annetine C. Gelijns, Alan J. Moskowitz
In few fields of public policy are the use and cost of services so powerfully driven by technological
change as in medicine. Every year numerous new drugs, devices and procedures emerge from the
R&D pipeline, and subsequently find their expansion (in terms of new populations and indications) in
everyday clinical practice. Policy makers have created a range of supply- and demand-side tools to
shape the processes of technological change, and, in recent years, have expanded their investment in
evaluative research to better inform such policy decisions.
This paper addresses three under-examined challenges in using the resulting evidence: those
inherent in the dynamics of technological change itself; those inherent in the analytical enterprise; and
the ways in which political factors (i.e. value judgments of stakeholders) shape the translation of
evidence into policy decisions. Whereas much attention has been given to obtaining more rigorous
evidence about technology, the design of institutional arrangements and processes that seek to blend
evidence with politics has been relatively neglected. These institutional processes deserve careful
cross-national study.

Göhler, Alexander
Massachusetts General Hospital, Harvard University, Faculty of Medical School and School of Public
Health, Institute for Technology Assessment
101 Merrimac Street, 10 th floor, Boston MA 02114, United States
Telephone: +16 177 267 429, Telefax: +16 177 269 414
Email: agohler@hsph.harvard.edu
Decision-analytic Evaluation of the Clinical Effectiveness and Cost-Effectiveness of
Disease Management Programs in Congestive Heart Failure in Germany
Congestive heart failure (CHF) is a disease with high public health relevance as its current prevalence
is estimated to be 1-2 % in the general population. The prognosis is poor, and the economic burden is
extremely high. Since its prevalence increases with age, it most likely will be one of the most
challenging diseases within the next decade.
Disease management programs (DMP) in the care of CHF have been successfully installed within the
last decade showing improved outcomes and reduced readmission rates. These programs include
medical and nursing care as well as disease education for the patient and continuing support after
discharge. We performed a meta-analysis of 36 randomized controlled trials (RCT) investigating DMPs
from 13 different countries, and found that DMPs lead to a statistically significant reduction of overall
mortality by 19 % and of overall rehospitalization by 16% within nine months. In a subsequent metaregression
analysis, we identified mean age and gender as the important variables explaining the
statistically significant heterogeneity across RCTs.
We developed a Markov model reflecting the natural course of disease in patients with CHF and
developed a database that stores relevant cost items for the treatment of CHF in Germany. As the
number of hospitalizations is the most published indicator regarding progression of disease and
prognosis, we chose 6 Markov-states for our model, which represent the number of past
rehospitalizations (0, 1, 2, 3, 4+) and death. Expected costs and years of life gained are calculated in
monthly cycles over a lifelong time horizon. To estimate age- and gender-dependent probabilities of
being hospitalized and/or dying, we used patient-level data from the SOLVD trial and data from the
Swedish hospital registry. The model considers mean lengths of hospital stay, mortality at home and in
the hospital, and costs associated with each clinical state or event. The model was externally validated
with data from the control arm of 7 different studies included in out meta-analysis. For all seven
studies, the model’s prediction of the one-year all-cause mortality was within the 95 % confidence
interval of the studies’ observation.
We performed a decision-analytic cost-effectiveness analysis from the societal perspective. Based on
our decision analysis, disease management programs in the care of patients with congestive heart
failure are likely to be highly cost effective. DMP increases life expectancy in patients with CHF on
average by 105 days and lifetime cost by approximately € 1,200. Using a discount rate of 5% the base
case incremental cost effectiveness ratio (ICER) was € 4,080 per LYG. Even under the conservative
assumption that DMP only has an effect on the first rehospitalization; DMP is cost-effective when
compared to other well-accepted medical interventions. Sensitivity analyses showed that the ICER
was sensitive to age, gender and the efficacy of disease management programs and insensitive to
costs of care for CHF, and the duration of the DMP effect. Future studies should be performed to
evaluate the specific efficacy of different DMP aspects.

Halamová, Dáša
University of P. J Safarik, Faculty of Natural Science, Department of Inorganic Chemistry
Moyzesova 11, 04001 Košice, Slovak Republic
Telephone: +42 190 421 9577
Email: dasa.halamova @upjs.sk
The Use of Mesoprons Materials in Drug Delivery
Dáša Halamová and Vladimir Zele
The aim of the project is preparation of mesoporous materials and their application as drug delivery
systems. The use of regular mesoporous matrix for drug delivery could take an advantage of slow and
controlled release of the drugs to organism. This could lead to prolonged efficiency of the drugs, less
frequent doses and consequently to minimalise the side, negative effects of the tested drugs.
Prepared mesoporous materials will be characterized by thermogravimetry, nitrogen adsorption, IR,
UV-VIS spectroscopy, electron microscopy, before and after incorporation of the drugs into porous
structure. In vitro drug release from matrix to simulated body fluids will be studied by HPTLC
chromatography.

Hammitt, James K.
Professor of Economics and Decision Sciences; Director, Harvard Center for Risk Analysis, Harvard
University, School of Public Health
718 Huntington Ave., Boston MA02115, United States
Telephone: +1 617 432 4343, Telefax: +1 617 432 0190
Email: jkh@harvard.edu
Economic and Health Utility Measures in the Evaluation of Patients’ Preferences for
Health Risks and Outcomes
Quality-adjusted life years (QALYs) and willingness to pay (WTP) are alternative measures of the
value of changes in health and health risk. Although both methods are based on individual
preferences, the underlying assumptions differ. These differences yield systematically different
conclusions about the relative value of reducing health and mortality risks to individuals that differ in
age, pre-existing health conditions, income, risk aversion, and other factors. The choice of which
method to use depends on judgments about what constraints should be placed on individual
preferences and what factors should be considered in aggregating preferences across people.

Herholz, Karl
University of Manchester, Faculty of Medicine; Director, Wolfson Molecular Imaging Centre
27 Palatine Road, M20 3 LJ Manchester, United Kingdom
Telephone: +44 161 2750014, Telefax: +44 161 2750003
Email: karl.herholz@manchester.ac.uk
Trends in Medical Imaging and their Potential Impact on Diagnosis and Treatment
The past twenty years have seen a multitude of new imaging technologies being introduced first into
science, but usually very quickly also into clinical practice. These include fast X-ray computed
tomography (CT) techniques, magnetic resonance imaging (MRI), single photon emission computed
tomography (SPECT) and positron emission tomography (PET). Of those, MRI for high-resolution
examination of abnormal structure certainly has made the most significant impact in terms of breadth
of applications, number of examinations and associated cost. Beyond that, functional imaging
techniques (fMRI, SPECT, PET) are being pursued mostly in the scientific domain, but clearly PET
which is the most costly of those has now well established clinical indications in oncology. Modern
tomographic imaging is 3D (volume) or 4D (volume + time course) imaging with associated challenges
for data processing, opening fascinating possibilities for integration into surgical and radiotherapy
planning (including procedures performed by robots and virtual reality scenarios, e.g. for training and
remote control).
Consequences for clinical medicine and health care are multifaceted and complex, but some trends
can be identified. The advent of CT as the first truly tomographic technique in the mid 70s and early
80s had substantial impact on our capabilities to diagnose major diseases, e.g. of the brain, but
beyond that the influence of the other techniques was more modest because diagnostic techniques
were already quite successful before their advent, leaving not too much room for substantial
improvement. MRI has the advantage of coming without ionising radiation. The obvious improvements
of the new techniques to visualise abnormalities often raise huge therapeutic expectations which
cannot easily be met. Improved sensitivity to detect abnormalities (e.g., carcinoma metastases) may
lead to detection of more advanced disease and thus exclude some therapeutic options that would
have been available at an earlier stage. This is contrary to public expectations, but reducing therapy
can lead to financial savings and avoidance of unnecessary side effects. On the other hand, improved
sensitivity may lead to earlier detection of disease, an effect that for example is obvious for multiple
sclerosis (MS) and primary low-grade brain tumours. Thus, we are diagnosing severe chronic
diseases at a stage where only intermittent unspecific symptoms are present, and the obvious hope is
that this would not stigmatise individuals but improve overall prognosis. Although the value of
intensified early therapy has been demonstrated in MS, its efficacy still low and comes at a high cost.
Probably the most promising aspects of the new imaging techniques are not related to improved
diagnosis, but to improvement of individual therapy planning. For example, this can be demonstrated
for surgical planning of brain tumours in critical locations, and new molecular imaging techniques aim
at determining the individual receptor status for targeted chemotherapy. Yet, controlled clinical studies
to actually demonstrate such marginal benefit are largely unavailable and will be very difficult to
perform.
In summary, the enormous advances in imaging technology improved diagnostic sensitivity and
grading of disease. Their contribution to better individual therapy planning is apparent but
improvement of overall outcome is difficult to assess and verify in controlled studies.

Holle, Rolf
GSF – Research Centre for Environment and Health, Intitute of Health Economics and Health Care
Management (IGM)
Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
Telephone: +49 89 3187 4192, Telefax: +49 89 3187 3375
Email: holle@gsf.de
Pros and Cons of Threshold Values in Economic Evaluation
The use of a threshold value for the incremental cost-effectiveness (CE) ratio to demarcate
interventions which are considered cost-effective from those that are not, has been discussed in the
literature from various viewpoints. Some authors question the theoretical foundations (e.g. Gafni &
Birch, 2006), but in practice at least “soft” thresholds seem to be implicit in decisions or guidance by
institutions such as NICE (Taylor et al., 2004). In addition, in most published CE analyses a CE
threshold is explicitly referred to and an international consensus concerning its value seems to have
evolved in recent years. CE thresholds are also implicit in more recent methodology as net benefit
analysis or CE acceptability curves.
I will present some arguments concerning the usefulness and the problems of CE threshold values
from practical and theoretical perspectives. These include the effect of CE thresholds on pricing and
the neglect of uncertainty in CE estimates.
In summary, economic evaluation needs threshold values as an orientation, but misuse should be
prevented by setting high scientific standards and allowing a very flexible practice in reimbursement
decisions.
Gafni A, Birch S: Incremental cost-effectiveness ratios (ICERs): The silence of the lambda. Social Science &
Medicine 62 (2006), 2091-2100
Taylor RS, Drummond MF, Salkeld G, Sullivan SD: Inclusion of cost effectiveness in licensing requirements of
new drugs: the fourth hurdle. British Medical Journal 329 (2004), 972-975

Ispas, Ioana Rodica
EU Advisor for Bioethics,Genomics and Health, Ministry of Education and Research, European
Integration and International Cooperation Division
21-25 Mendeleev Street, District 1, 010362, Bucharest, Romania
Telephone:+4021.318.30.64, Telefax: +4021.318.30.53
Email: iispas@mct.ro
Ethical Concerns in Case of Dual Use of Medical Technologies
Health technologies are defined very broadly as: all methods used by health professionals to promote
health, diagnose, prevent and treat disease, and improve the rehabilitation and long term care.
Nowadays there are few technologies with dual use: medical and security purposes derived from
biometric research: iris scanning, DNA fingerprint, multimodal technologies for face identification etc.
For those technologies is rather difficult to establish a border line for ethical concerns in medical and
security area taking into account that many times public concerns regarding the possible damage to
the human body are linked with fear about secondary uses of data acquired. DNA identification is
based on techniques using the non-coding tandemly repetitive DNA regions.
In this moment this technology is not widely recognized as biometric recognition technology because
is not automated process (takes some hours to create a DNA fingerprint) but scientifically speaking
provides a high degree of accuracy and it is the most distinct biometric identifier available for human
beings. The statistical sampling shows a 1 in 6 billion chance of two people having the same profile.
The article is focused on the common ethical issues raised by the dual use of DNA fingerprint
technique in case of genetic testing for identifying a specific disease and in biometrics (the donor
consent and protection, genetic discrimination and stigmatization, access to DNA databases, transfer
of samples and data to third parties, the IPR) showing that also the society has a dual moral system
for assessment of these technologies depending on the usage. The impact of DNA databases usage
and storage will be taken into consideration. Setting up the institutional framework for data protection
as well as the regulations for data protection and manipulation of personal data represents a challenge
for civil society in relation with DNA fingerprint databases. A briefing discussion of Romanian
regulations in data protection (law 677/2001) linked with DNA fingerprint is assured.

Jena, Anupam B.
University of Chicago, Department of Economics and School of Medicine
1755 E. 55 th Street, Room 504, Chicago IL60615, United States
Telephone: +1 773 324 4178
Email: ajena@uchicago.edu
The Macroeconomic Value of Life
Tomas Philipson, Casey Mulligan, Eric Sun, Anupam Jena
Secular gains in longevity and health in the United States and the developed world have been
substantial by any measure. What is the economic value of these gains? A substantial amount of
recent work indicates it is the most important economic advancement over the last century, as
indicated by a growing literature that attempts to value these gains in health relative to gains in percapita
income. For the US, Cutler et al. (2004), Nordhause (2005), and Murphy and Topel (2006) all
estimate that the gains in longevity in the US have been on par in value to the gains in material well
being from income growth as measured by traditional income account measures. For the world as
whole, Becker et al. (2005) argue that changes in inequality are greatly affected by incorporating
longevity into national income accounting. This strand of work uses traditional micro-economic
methods to monetize the value of gains in longevity, see e.g. Rosen (1988), and then compare those
monetized gains to income gains.
However, longevity affects the levels and growth of economic income and therefore ignoring these
effects in the value of increased longevity may be misleading. There are several ways in which
longevity may affect income. The most direct is through population size. Ever since the pioneering
work of Malthus, economists have appreciated the importance of the effects of population size on
economic well-being and national income levels. Indeed, as fertility has been falling and longevity
growing, the growth in longevity is an important source of the increased size of populations in many
countries, and thus an important source of the effects of population on growth and vice versa. Another
way in which increased longevity may affect income is through increased savings incentives and thus
capital accumulation. Lastly, an important non-Malthusian mechanism by which longevity may affect
income is through the increased incentives for innovation induced by the larger markets of longer living
individuals. Indeed, there is long standing and large literature stressing both the negative and positive
impact of such longevity induced population growth on both economic income levels and growth.
In this paper, we attempt to reconcile these two separate strands of research efforts by incorporating
the general equilibrium effects of increased longevity in estimates of the value of the gains in longevity.
Our approach is in contrast with previous work assessing the value of the growth in longevity which is
a partial equilibrium approach, assuming non-existent the important demographic effects that impact
economic growth. When longevity is increased, it raises population size, which in turn impacts income
levels, though with different effects dependent on whether there are decreasing or increasing returns
to scale in production. Our general argument is that the general equilibrium price-effects induced by
increased longevity greatly alter estimates of the value of this increased longevity from those obtained
using a partial equilibrium approach that ignores them.

John, Jürgen
GSF National Research Center for Environment and Health, Institute of Health Economics and Health
Care Management
Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
Telephone: +49 89 3187 4129, Telefax: +49 89 3187 3375
Email: john@gsf.de
Is Efficiency an Ethically Defendable Criterion for Allocational Decisions in Health
Care?
In the health economic literature, a statement on the allocation of resources in health care can
frequently be found showing an appreciation of the two criteria of effiency and justice or fairness as
two conflicting values which are to be weighed against each other. Following Taurek's (1977) thesis, I
will argue that aggregates of individual (dis-)advantages or (dis-)utilities do not have any intrinsic
ethical value. In consequence, efficiency in health care in the sense of realizing the maximum health
gain achievable with a given amount of resources, does not have an ethical foundation on which a
normative ranking of alternative allocations of resources could be based.
One possible way of reconstructing the concept of efficiency on a firm ethical basis, might be to derive
the principle of health maximisation from a virtual social contract reflecting the societal preferences
over the allocation of health care resources. Evidence from numerous empirical studies, however,
demonstrates that public response conflicts with the orthodox economic model of health maximisation.
There is prima facie evidence for an additional broad range of social preferences with respect to the
severity of a health state per se; some personal characteristics, including age;, contextual factors
(explaining, e.g., the high degree of acceptance of the rule of rescue); communitarian values as the
maintenance of solidarity; or achievement of a'fair innings', among other things.
In an ethical perspective, the role of the principle of efficiency in allocating health care resources
remains unclear. I suggest that defendable principles for allocational decisions should be derived in an
iterative way combining empirical studies of population values and systematic ethical analysis as
proposed by Richardson (2002)in his approach described as "empirical ethics". Maybe that in this
process a meaningful and ethically firm concept of efficiency will be identified.

Kapeniece, Andra
Riga Stradina University, Clinical Hospital “Gailezers”
Stirnu str. 19a-48, 1035 Riga, Latvia
Telephone: +371 29157948
Email: Andra_K@excite.com
Biomedical Ethics and Human Rights
People have discussed the place of ethics in the effort to renew the health-for-all strategy, and given a
prominent place to equity as fundamental to it. But the challenge goes far beyond definitions and
principles. Putting these ideas into effect means disseminating them throughout multiple sectors,
through many different channels, in ways that can be incorporated into the day-to day affairs of
nations, organizations, communities and individuals. A key question is whether the moral reasoning of
equity will be translated into policy leverage. In trying to answer that question, we can seek guidance
from two related fields - biomedical ethics and human rights.
Biomedical ethics has become strikingly influential in medical practice and law, and in shaping the
expectations of patients and the public. How did this happen? On the one side, science and
technology were seen as a threat to patient and community wellbeing, and on the other, the health
professions and ethicists responded to this concern. This led to a gradual but pervasive influence of
biomedical ethics in patient care, public health, corporate policies, government measures, and training
programmes for health personnel. Concern for human rights has also become highly influential in our
time, largely through concentration on legal obligations of nation states. A wide variety of international
organizations and nongovernmental organizations have developed vigorous advocacy approaches
that have given public and political visibility to human rights issues.

Kollek, Regine
University of Hamburg, Research Centre for Biotechnology, Society and the Environment
Falkenried 94, 20251 Hamburg, Germany
Telephone: +49 40 42803 6309
Email: kollek@uni-hamburg.de
The Subjective Value of Genetic Information: Ethical and Social Considerations in the
Evaluation of Genetic Testing Technologies
Professor Regine Kollek has chaired the research group on “Technology Assessment in modern
Biotechnology and Medicine” since 1995. Her research focuses on foresight and evaluation of modern
biotechnology in medicine and the neuro sciences, on methodological questions in technology
assessment, on the dynamics of biomedical innovation in health care, and on the sociology of
biomedicine. Prior to her current position, Regine Kollek has served for a variety of research institutes,
including the University of California School of Medicine at San Diego and the Enquete Commission of
the German parliament on the “Potential and Risk of Genetic Technologies”.

Körfer, Reiner
Heart and Diabetes Center North Rhine-Westphalia, Ruhr University of Bochum
Georgstr. 11, 32545 Bad Oeyenhausen, Germany
Telephone: +49 57 31 971 331, Telefax: +49 57 31 971 820
Email: rkoerfer@hdz-nrw.de
Trends in Transplantation Technology
R Körfer, G Tenderich:
The development of Heart Transplantation (HTx) as a clinical tool for the treatment of endstage heart
failure (HF) necessitated the contribution whose work has taken generations. The fields of
immunology, pathology, medical ethics and device engineering have contributed to the development
and success of this procedure.
Due to several reasons currently Heart Transplantation is limited by shortage of suitable donor organs.
Methods to increase the number of available donors continue to be evaluated, as research helps to
expand the number of medically acceptable donors.
Also techniques of myocardial protection continue to improve, which may increase the ability to match
patients and donors and may influence early and long term results by reduction of reperfusion injury.
The initial clinical experience of our institute represents the first clinical step changing the dogma of
cold storage towards warm perfusion.
Xenotransplantation remains an option. In 1989 Baby Fae caught the world’s attention when L. Baily
used a baboon heart to replace the heart of the neonate, but the procedure ultimately failed.
There is an ongoing debate on immunological, infectious and ethical issues that are complex and
perhaps unresolvable. Xeno Transplantation does not represent a clinical option yet.
Artificial hearts may prove to be the answer to many HTx related problems, as donor supply, rejection,
immunosuppression and related diseases.
Actually clinical data clearly show an advantage of the devices as bridge to transplantation-tools,
destination therapy is only indicated in case of contraindication for HTx.
We report on our experience of nearly 1600 HTx and almost the same amount of device implantations
within the last 17 years.

Krauth, Christian
Hannover Medical School, Department of Epidemiology, Social Medicine and Health Systems
Research
Carl-Neuberg-Str. 1, 30625 Hannover, Germany
Telephone: +49 511 532 4426, Telefax: +49 511 532 5347
Email: krauth.christian@mh-hannover.de
Economic Evaluation of Early Monotherapy Versus Delayed Combination Therapy in
Patients with Acute Hepatitis C
Christian Krauth (1), Alexander Haverkamp (1), Johannes Wiegand (2), Tilman Gerlach (3), Heiner Wedemeyer,
(2), M.P. Manns (2), and Charalabos-Markos Dintsios (1)
1 Department of Epidemiology, Social Medicine and Health System Research, Hannover Medical School,
Hannover, Germany
2 Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover,
Germany
3 Medical Department II, Klinikum Großhadern, Institute for Immunology, Munich, Germany
Introduction: 500,000 to 800,000 people in Germany are chronically infected with hepatitis C virus. The
incidence of newly reported cases of hepatitis C in Germany was 10.5 per 100,000 inhabitants. For
Germany costs relating to the hepatitis C infection have not yet been fully determined, but are
expected to reach € 1 billion per year. Early effective antiviral treatment will be able to lower the
burden of hepatitis C and individual prognostic factors of patients as well as health-economical issues
are to be considered.
Objectives: Comparative evaluation of two options for the treatment of acute hepatitis C: immediate
monotherapy of all patients with (pegylated) Interferon versus delayed combination therapy of patients
who do not feature selfhealing within three months with Interferon and Ribavirin including costs, effects
and cost-effectiveness.
Methods: The economic evaluation is based on three completed prospective (non-randomised)
outcome studies. In the monotherapy studies (n=128) patients were treated with 5 million units
Interferon alpha-2b daily during the first 4 weeks and three times a week during the following 20 weeks
or weekly with 1,5µg per kilogram pegylated Interferon alpha-2b over a period of 24 weeks. The
comparative evaluation focused on direct medical costs and included physican's fees, laboratory costs
as well as medication costs, taking a societal perspective. Evaluation data were based on the
examination logs of study participants. Indirect costs were raised ex post by enquiry of participants
and physicians in monotherapies. Costs were valued at 2002 market-prices.
Results: Both monotherapy and combination therapy of hepatitis C prove a similarly high effectiveness
(healing rate: 87% vs. 90%). Direct medical costs of immediate therapy (€ 7,034/patient) are € 351
lower than those of delayed therapy (p=0.8). Pegylated compared to unpegylated Interferon yields €
511 additional costs per patient (p=0.01) in monotherapies. Considering the current genotypedepended
therapy standard and the observed rate of self-healers average costs per patient amounts
to € 10,848 and is about 50% higher than costs of the immediate monotherapy.
Conclusions: As there are no significant differences in treatment effectiveness, monotherapy seems to
be slightly more cost-effective, whereas medication reaches more than 90% of direct costs.

Lindholm, Torun
Mälardalen University, Department of Social Sciences
Box 883, 721 23 Västerås, Sweden
Telephone: +46 21 10 14 72
Email: torun.lindholm@mdh.se
Group Membership and Medical Decision Making
It is well documented that our evaluations and judgments of other individuals often depend on
the social group to which the individual belong. In particular, people who belong to our own
groups are judged more positively than those who belong to some out-group. Such groupbased
biases in judgments may occur unintentionally and subconsciously, and can be
unrelated to the perceiver’s conscious attitude towards the out-group. Research further
reveals that this type of bias may sometimes affect medical decision-making.
The current research investigates the influence of group membership on decisions and
decision-making processes in cases of euthanasia. Study 1 examined effects of patient and
juror gender on a decision in a court trial regarding a phycisian’s use of euthanasia. Swedish
jurors read a case description of euthanasia in a severely brain-damaged patient, and were
asked whether they would judge the euthanasia in the case to be legal. Jurors tended to be
more supportive of euthanasia when it was used on patients who belonged to the opposite
gender.
Study 2 examined effects of group membership on cognitive decision processes. Specifically,
we investigated whether the tendency to increase the perceived attractiveness of the chosen
decision alternative relative to the non-chosen alternative after the decision, so called
consolidation, would vary as a function of the patients in-group/out-group status and
perceived social support for the decision. Swedish participants read a case vignette
describing a terminally ill teenage boy who asks his physician for a drug to committ suicide.
The patient either had a Swedish, or a Turkish name, and participants were asked to decide
whether the physician should comply to the boy’s request or not. After the decision,
participants were informed that either a majority or a minority of their peers had chosen the
same alternative as they had.
Results showed that participants who made their decision about an in-group member
consolidated their decision more if they received minority, as compared to majority feedback.
However, this pattern reversed when the decision concerned an ethnic out-group member.
Thus, participants in this condition increased the attractiveness of their chosen alternative
when they were informed that they were in majority, but did not show consolidation of their
decision when informed that they were in minority. Results imply that people may be more
susceptible to the influence of others’ opinions when making decisions of out-group as
compared to in-group members.

Lühmann, Dagmar
University of Lübeck, Institute for Social Medicine
Beckergrube 43 – 47, 23552 Lübeck, Germany
Telephone: +49 451 799 2538, Telefax: +49 451 799 2522
Email: dagmar.luehmann@sozmed.uni-luebeck.de
Ethical analysis in pragmatic Health Technology Assessment - asking for the
impossible?
Dagmar Lühmann, Heiner Raspe
Institute for Social Medicine, University of Lübeck
By definition comprehensive Health Technology Assessment comprises the assessment of a
technology's safety, efficacy, effectiveness, economic consequences, its organisational and legal
impact as well as its social and ethical implications. Although valued very high by almost all HTA
institutions, ethical aspects are considered difficult to deal with and they are rarely addressed in
pragmatic HTA.
When thinking about HTA and ethics two dimensions must be distinguished: first, the ethics of HTA
and its embedding in the health care system and society; and second, the ethical implications of use
or non-use of a technology being assessed. For the first dimension issues like the following should be
discussed: What are the ethical implications of choosing HTA as an instrument for decision-making?
What are the consequences of choosing a (standard) methodology for HTA? Which values determine
the choice of technologies for assessment? Which values determine the precise research questions?
The second dimension becomes relevant during the assessment of a specific technology or group of
technologies. Do the consequences of use or non-use of a technology interfere with values held by
any stakeholder? This question may only be answered after systematic exploration of the
multidimensional sequels of technology adoption - from the relevant perspectives involved.
Furthermore it requires agreement on the basic ethical principles to be respected.
Stemming from TA, there is a number of elaborate methodological approaches for assessing ethical
implications of a technology with most of them being to time and resource consuming for pragmatic
HTA. Ongoing research focuses on the development of eclectic approaches to enable pragmatic HTA
to at least systematically identify areas of ethical tension associated with the use or non-use of a
health technology. The most prominent projects in the area are probably the activities of the
EUNetHTA and INAHTA working groups.

Magnezi, Rachel
Ariell College, School of Health Science, Department of Health Systems Management
84 revivim ST, 40800 Rosh Ahayin, Israel
Telephone: +972 39 013 182, Telefax: +972 39 013 221
Email: rachelim2@bezeqint.net
Outsourcing Primary Medical Care in Israeli Defense Forces: Decision-makers' versus
Clients' Perspectives
Racheli Magnezi, Rachel Dankner, Ron Kedem, Haim Reuveni
Background: Decision-makers in the Israeli Defense Force (IDF) have determined that the Medical
Corp (MC) would outsource the primary care services required by career soldiers to a skilled civilian
health care provider, in an attempt to improve efficiency, quality and "image" of the MC care system,
while controlling expenses.
Methods: A cross sectional survey to reveal decision-makers' considerations for outsourcing primary
care for career soldiers and to evaluate whether these considerations match career soldiers
satisfaction level parameters was conducted during February 2002 in IDF bases and civilian primary
care clinics.
Results: Medical Corp decision-makers are concerned about loss of professional prestige and
dependence on the civilian system. A high level of satisfaction following outsourcing was found among
career soldiers due to: medical staff attitude, pleasant facilities, quality of care, availability and
accessibility of medical care. Agreement about five factors was found among decision makers and
career soldiers: working environment, medical personnel attitude, quality and availability of medical
care, and patient satisfaction level.
Conclusions: Outsourcing of primary care from military to civilian providers gives high client
satisfaction level. The reasons and results of outsourcing described are relevant to other large
organizations worldwide.

Marckmann, Georg
University of Tübingen, Department of Medical Ethics
Schleichstr. 8, 72076 Tübingen, Germany
Telephone: +49 7071 29 78032, Telefax: +49 7071 29 5190
Email: georg.marckmann@uni-tuebingen.de
Ethical Limits of Modern Medical Technology
Technology has tremendously improved the diagnostic and therapeutic possibilities of modern
medicine, certainly to the benefit of many patients. Of course, modern medical technology has limits:
There are still many diseases for which no effective interventions have been developed so far, some
technologies are not ready for clinical application yet. Researchers are working hard to overcome
these factual limits. Given the unquestionable benefit for many patients, it might seem heretic to ask,
whether there should be ethical limits to medical technology, implying that available technological
options are not used for moral reasons. However, medical technologies – like many other technologies
– sometimes demonstrate a characteristic ambivalence, i.e. both positive and negative effects. For
example, patients with multi-organ failure greatly benefit from life-saving intensive care technologies,
but in some cases this benefit becomes questionable if it just prolongs the patient’s suffering without
any prospect of recovery.
The ambivalence of modern medical technology requires a careful ethical analysis and – as a result –
setting limits to the development and/or application of the technology. In my presentation I will discuss
the normative basis for this ethical evaluation and develop an ethical framework for the ethical
assessment of medical technologies. These ethical considerations focus both on the individual
(obligations of beneficence, non-maleficence and respect for autonomy) and on society (obligations of
distributive justice). Based on the example of clinical decision support systems, I will show how these
general ethical principles can be applied to a specific medical technology.
The technological progress is considered as one of the most salient factors underlying the continuous
(and ubiquitous) increase of health care costs. Given the tight financial constraints we face in almost
all health care systems around the world, the thorough assessment of the cost-effectiveness of
medical technologies becomes a special importance. This is not only a matter of economics but rather
an ethical requirement: We are obliged to make the most efficient use of the scarce health care
resources so that as many patients as possible can be treated. Economic evaluations provide
instruments for the formal assessment of benefits (health gain for the patients) and costs of medical
technologies. However, they involve several normative assumptions and raise the difficult question
how to define and justify a cost-effectiveness threshold for medical interventions. I will discuss how
these methods can be applied to assess medical technologies in an ethically appropriate way.
Given the ambivalence of modern medical technologies, a categorical approval or denial as a result of
the ethical assessment often seems to be inappropriate. The challenge is rather to develop a set of
ethically justified criteria for the development and use of medical technologies that try to ensure that
the patients benefit while simultaneously minimizing (the risk of) negative effects, both to the individual
and to society. I will present an exemplary set of ethical criteria for the development and use of clinical
decision support systems.

Martín-Sanchez, Fernando
Head of the Medical Bioinformatics Department, National Institute of Health Carlos III, Spain
Ctra. Majadahonda a Pozuelo, Km 2., 28220 Majadahonda, Madrid, Spain
Telephone: +34918223219, Telefax: +34918223259
E-Mail: fms@isciii.es
Molecular Medicine and Individualized Healthcare: Defining the Research Agenda
The Human Genome Project and related technologies have opened the door to new approaches in
biomedicine with a profound impact on the delivery of clinical care. New devices will allow to locate
genetic diagnosis closer to the point-of-care. Developments in pharmacogenetics offer the possibility
of fine-tuning drug therapy in line with patients’ genetic profile. Functional studies will permit a much
more precise classification of disease. Population-oriented studies are already providing new insights
into the molecular causes of many diseases. This presentation will introduce the key concepts of
molecular and individualised healthcare. The main opportunities in diagnosis, therapy and prevention
will be described. Current gaps and limitations to individualised healthcare will be analysed and
initiatives that are being launched to overcome these barriers will be explained.
The SYMBIOmatics project, a Specific Support Action (SSA) funded by the IST Programme of the
European Commission is an information gathering, analysis and dissemination activity that aims to
exploit synergies between bioinformatics and medical informatics as well as identifying addressable
research challenges for the medium term future. The project is documenting the state-of-the-art in
biomedical informatics in Europe and identifying areas of new opportunity through the collection of
insights from experts in the field and the application of bibliometric and data and text-mining methods
for analysing the content of the relevant scientific literature. Areas of opportunity are being
documented and prioritised. A White Paper summarising the findings is planned to be completed by
Nov 2006 with the aim of providing input to future European scientific and funding policy.

Meltzer, David
Center for Health and the Social Sciences, Department of Medicine, Department of Economics, and
Harris Graduate School of Public Policy Studies, The University of Chicago
5841 S. Maryland Ave. MC 2007, Chicago IL, 60637, United States
Telephone: +1 773 702 0836, Telefax: +1 773 834 2238
Email: dmeltzer@uchicago.edu
Diffusion of Innovation through Social Networks and the Origins of the Medical
Practice Variations
A large literature has demonstrated variation in practice patterns of physicians across small areas in a
vast range of settings. These small area variations do not appear to result from differences in patterns
of disease or other patient factors, or from readily observable attributes of the health care system or its
providers, including variables such as insurance status and physician specialty. This has led to
speculation that small area variations may be shaped by the local reinforcement of physician practice
patterns by social network connections with colleagues in which physicians are more likely to adopt
the practice patterns of their nearby colleagues. However, previous studies of this topic have lacked
data on exogenous variation proximity of and social network connections with colleagues so that the
effects of exposure to new practice patterns can be rigorously studied.
We report a series of resuts concerning the origins of practice variations that arise from a set of
studies of practice patterns amomg academic physicians attending on the general medical services at
the University of Chicago and 5 other academic medical centers. We begin with an examination of the
influence of local physician practice patterns on the practice patterns of neighboring physicians. In
particular, we illustrate how the use of a new treatment for blood clots spreads among physicins based
on exogenously determined social network connections among physicians, producing local variations
in practice patterns during the period of diffusion. We then proceed to illustrate how similar social
network connection among physicians can alter comparisons of patient outcomes between physician
groups in a multicenter study of the effects of physician specialization. We also examine the effects of
physician attributes on the propensity for physicians to learn new practices from one another, finding
strong evidenece that physician learning pattens are driven not just by geographic proximity but also
by similarity of physicians with respect to gender, age, and medicial school status.
Together, these results suggest a strong effect of social network connections among physicians in
determing practice patterns and their variation across geographic areas. The work also suggests that
proximity of physicians with respect to other attributes such as age and gender may produce similar
tendencies for the development of similarities in practice patterns. Searches for such patterns by may
generate valuable opportunities to identify and reduce harmful variations in practice patterns.
Knowledge of the origins of practice variations in social network connections also suggests new ways
to use opinion leaders and other manipulations of the physician practice environment to reduce
harmful practice variations and produce desired changes in physician practice patterns.

Mihalas, George I.
Victor Babes University of Medicine and Pharmacy; President, European Fereration of Medical
Informatics (EFMI)
Eftimie Murgu Sq. no.2, Code 300 041 Timisoara, Romania
Telephone and –fax: +40 256 490 288
Email: mihalas@umft.ro
How Can Computer Simulations of Biological Processes Support Medical Decision
Making?
1. Introduction
Among the many technologies which can revolutionize healthcare, IT&C occupies a privileged
position, mainly due to the large palette of applications. This essay is dedicated to one such
application: use of computer simulation as a support for medical decision.
2. Theoretical background
a) Medical decision
Medical practice comprises different activities rolled usually in a well established order. An important
role is played by the decisions which are actually determinant for all the subsequent actions. We can
distinguish several medical activities/domains associated with decisions:
• Diagnosing
• Investigations selection
• Treatment optimization
• Public health policies
• Managerial decisions in healthcare
• Emergency and disaster strategies.
We can also scale the different procedures of decision making, getting the following classification of
methods:
• Empirical
– intuitive, observation based (personal experience)
• Experimental
– based on “best practice”
– statistically based (EBM, Baysian methods)
• “Theoretical”
– heuristic (reasoning)
– computer-aided decisions based on simulation
b) Medical information
The key element, common for all the types of decision mentioned above is "medical information". The
most ususal way to classify medical information is the one based on structural levels. As we can see in
Table 1, the term "medical information" covers a multitude of senses, with specific properties for each
level, corresponding to different medical disciplines, associated with different chapters of medical
informatics.
Table 1. Biomedical information classification using the structural level criterion
Levels of medical
information
Infra-individual
level
Individual level
Structural
level Studied by: Domain
molecular /
sub cellular
molecular biology genetics
cell / tissue cell biology
organ physiology
life
sciences
system brain theory cognitive sciences
body
(‘patient’)
paraclinical depts.
(investigations)
clinical depts. (diagnosis,
treatment)
medical
sciences
Corresponding
area of MI
bioinformatics
--------------------
physio & neuro
informatics
medical informatics

Supra-individual
level
community level public health
healthcare activity healthcare management
healthcare
sciences
healthcare
informatics
c) Computer simulation
As this essay refers to computer simulation support for medical decision making, it would be
appropriate to frame the corresponding terms.
• A simulation is an imitation of some real thing, state of affairs, or process representing certain
key characteristics or behaviors of a selected system
• Simulation is used in many contexts, including the modeling of natural systems or human
systems in order to gain insight into their functioning
• A computer simulation is an attempt to model a real-life situation on a computer. By
changing variables, predictions may be made about the system behavior
• Computer simulation has become a useful part of modeling many natural systems in physics,
chemistry, biology, and human systems.
3. Examples
The second part of the essay contains several examples of computer simulations used for medical
decision making. The palette of applications is very large; in order to systematize the available
information, this part is structured on the following subjects:
a) Conferences
– San Diego: 1998, 2004 (SCS – Soc.Comp.Simul.)
– Bologna: 2005
b) Institutions, Centers, Resources
– Medical Simulation Center – Israel
– Patient Simulation Center - St Michael’s Hospital, Toronto
– WinSAAM – NIH
– MedModel – ProModel, UT
c) Consequences
– Improving healthcare delivery and quality
– Education and Training
– Personalization in Healthcare
– Error Reduction
– Public Health Strategies
– Emergency and Disaster Situations
The method, generically called "Modeling and Simulation", has been successfully applied in several
fields - physics, chemistry, technology, medicine, sociology etc. There are professional organizations,
uniting scientists interested in this domain. One such organization is SCS - Simulo, which organized
several conferences in San Diego, Ca.
The 2004 edition had a comprehensive number of sections, covering almost all fields of application
(table 2).
Table 2.

Mihalas continued
There are also presented some institutions dedicated to 'modeling and simulation'.
The last part containes examples of applications with visible practical impact: improving qualitaty of
healthcare, reduction of errors, public health policies, etc.
Finally we mentioned our experience from the "Bio-View Project - a computer simulation package for
molecular biology, with user-friendly interface", under VIASAN Programme of the Romanian Academy
of Medical Sciences.
4. References (selection)
1. http://www.scs.org/confernc/wmc/wmc04/cfp/ichss04.htm - ICHSS'04
2. www.msr.org.il - Medical Simulation Center
3. http://www.jhsph.edu/publichealthnews/press_releases/2005/cummings_midas.html
4. http://www.wessex.ac.uk/conferences/2005/bio05/

Obermann, Konrad
University of Applied Sciences of the German Red Cross
Reinhäuser Landstr. 19-21, 37083 Göttingen, Germany
Telephone: +49 551 507 50865, Telefax: +49 551 507 50801
Email: obermannk@gmx.de
Public Participation in the Rationing of Health Care: Can Rawlsian Theory Applied in
Economical and Political Reality?
Background
The well-known trias of medical technology, demographic changes and changing patient preferences
leads to increased pressure on finite health care resources. Despite a potential of rationalisation some
form of priority setting is necessary.
At present, evidence-based medicine (from the clinical side) and economic evaluation (from the health
economics side) contribute primarily to the question on how to set priorities. In addition to these two
approaches, however, there is a case for involving the general population in priority setting.
The normative (philosophical) foundation
Why should there be any publicly provided health care in the first instance? John Rawls' in his 1971 “A
Theory of Justice” develops the idea of a “veil of ignorance”, behind which the contracting parties in
their “original position” meet. It is some form of a social contract and may serve as a starting point for a
Gedankenexperiment in which collective deliberation will define “just” health care.
This Rawlsian setting has been developed further by Norman Daniels (1985: Just Health Care) in
order to incorporate the design of health care institutions into this setting. He starts from the concept of
“fair equality of opportunity”, which should be secured for everyone by societal efforts and further
criteria of health care goals are explored in order to describe what health care should aim for. How
much effort should a society make to strive for equality between those with good luck and those with
bad luck in the “natural and social lottery”?
„[The] (fair equality of opportunity) is compatible with deep strands in our moral and political tradition,
indeed, with some of the more defensible features of that tradition. That agreement provides a lever
that is worth trying to pull“ (Daniels 1985, p. 229)
Practical issues
A major problem with this theoretical concept is its practical application. As Daniels notes: „(A
decision) requires careful moral judgement and a wealth of empirical knowledge about the effects of
alternative allocations. The various institutions which affect opportunity must be weighted against each
other.“ (Daniels 1985, p. 54). Furthermore, „[t]he fair equality of opportunity account does not give us
lessons in strategy for reform“ (p. 227 f.)
So, who is going to perform this weighing? Who can be the person(s) or institution(s) to task with the
role of an impartial judge behind the theoretical “veil of ignorance”. There is an urgent need to explore
options to find acceptable means to achieve just this in order to transform a thoughtful and appealing
philosophical approach into the technical and political reality.
Perspectives
Current information technology and the internet, especially the “Internet 2.0” with its change from
passive reception of information to an active involvement of larger part of the population could allow
for public participation at moderate cost.
Alternatively, novel techniques such as the “wiki” approach, the analysis of online-dicussions and
communities or “nextexpertiser”© could potentially be harnessed to identify and to quantify the public
interests and issues in health care.
Public participation should be explored as a means to identify important health care issues,
incorporate equity considerations into the efficiency calculus and distinguish between publicly and
privately financed health care.

Paiziev, Adkhamjon
Academy of Science of Uzbekistan, Department of Applied Physics
F.Khodjaeva str. 33, Academgorodok, 700125 Tashkent, Uzbekistan
Telephone: +998 71 1627940, Telefax: +998 71 1628767
Email: adxam_payziev@rambler.ru
Color Visualization of Blood Cell Patology
Paiziev A., Krakhmalev V., Institute of Electronics Uzbek Academy of Science, Tashkent
Introduction: Color visualization are widely spread in biological and medical studies of difference
samples. But for this purpose need special treatment of samples under expensive chemical
prepares. This procedure is changing native structure biomedical sample and lead to distorted its
image under microscope. Other method for color visualization is connected with using interference
microscope based on transmission of white light through bio-medical sample. But this microscope
have complicated additional and expensive optical system for getting two coherent light.
Materials & Methods: To get most cheep and convenient method color visualization human blood
cells, urine, saliva and other physiological liquids without any chemical treatment and using expensive
interference microscope we proposed new method based on using ordinary optical microscope and
special substrate on what we put the investigating sample. Measurements has been performed for
human blood cells , saliva and urine for health perfect and for difference stage cancer patients.
Method based on light interference reflected from sample surface and supporter.
Results: Developed new technique for fast in real time regime to get color image of human blood
cells without any chemical treatment. This method let us to determine chemical compounds of blood
cells by comparison this color image with calibrate color map. In Figure 1 and 2 showed example of
color image of human blood cells by new method and black and whit image by ordinary method what
used in medical practice.
Discussion and conclusion: We offer new method to get two coherent light based on biomedical
sample reflection and special no transparence supporter reflection of the white light . In result we
can see color interference picture (Fig.1.) of the biomedical sample under ordinary optical
microscope without using any chemical treatment and expensive interference microscope. This
method may be used in medical laboratory, hospitals, research centers and individual users for fast
public and self diagnostics.

Pandey, Ugrasen
Agra University, S.R.K.P.G. College, Department of Sociology
1 Roshanganj, 283203 Firozabad, India
Telephone: +91 941 256 2191, Telefax: +91 561 223 3040
E-Mail: us_pandey123@yahoo.com
Expanded Perspectives on Drug Education in India
Extension professionals in many states, recognizing they have a contribution to make in the war
against drugs, have identified drug education as a high priority. It also includes the misuse of
medicinal drugs which, according to Goodstadt,2 is our most widespread and serious drug problem.
Though both categories of drugs are potentially dangerous, one group consists of illegal substances
while the other is made up of drugs with legitimate therapeutic applications.
Programs that broadly address the drug problem, including the misuse of legally obtained medicinal
drugs and abuse of illegal street drugs, should distinguish between the concepts of abuse and misuse.
Drug abuse is the intentional and nontherapeutic use of any psychoactive (mind-affecting) substance,
including alcohol, that adversely affects the user's well-being. Drug misuse is inappropriately
prescribing or using therapeutic drugs, is unintentional, and those involved aren't seeking
psychoactive effects.

Pertile, Paolo
Catholic University Milan, Graduate School in the Economics and Finance of Public Administration
(DEFAP)
Via Lanzone 29, 20123 Milan, Italy
Telephone: +39 340 645 8769
Email: paolo.pertile@unicatt.it.
An extension of the real option approach to the evaluation of health care technologies:
the case of Positron Emission Tomography‡
Investments in innovative health care technologies often require significant capital outlays, which are
in most cases irreversible. Decisions have typically to be taken subject to uncertainty, especially when
the the time horizon of the investment is long enough. The typical approach to uncertainty in the
evaluation is based on expected values. However, unless the investment is fully reversible or a ‘now or
never’ decision, this approach fails to take into account the flexibility embedded in the investment
decision (Palmer and Smith, 2000, JHE). For example, it is often the case that there is some discretion
at least over the timing of the investment. The key insight behind the real option approach, which
builds on the analogy with financial options, is that the information available at different points in time
is not the same. As long as the irreversible decision has not been taken, there is not an obligation, but
just an opportunity (option) to invest, which will be exercised only if it proves profitable, given the
information available at a certain point in time.
An application is provided in the paper to the evaluation of Positron Emission Tomography (PET).
Several characteristics of this innovative diagnostic technology that is mainly used in oncology make it
an interesting application. First, the capital cost is high and the decision irreversible to a large extent.
Moreover, besides the flexibility on the timing of investment, there is also some flexibility on the size of
the project, the alternative being between investing in a full PET Centre, which allows to produce the
radiopharmaceutical, and making a smaller investment in the PET scanner only, which requires to buy
the tracer from another Centre.
Because of the relevance of fixed and capital costs of the equipment, the number of scans performed
is a key variable for the economic evaluation. This variable is perceived as uncertain. The main reason
why it is so is that in the recent history of PET the number of cancers for which the efficacy of the
exam has been proved has been constantly increasing. Since the number of studies published so far
is limited, it is not possible to know what the future evidence will be. There are in fact other sources of
uncertainty influencing the number of exams performed by one scanner, such as the total number of
diagnostic exams required in the catchment area and the number of new PET scanners whose
location will be such that patients may be attracted from it. Which of these variables are actually
relevant depends on the viewpoint adopted.
In the paper, both the societal and the provider’s viewpoints are adopted. In the first case, it is
assumed that some regulatory power exists, such that the strategic interaction with other providers
that could attract patients from the same area is not an issue. This enables to define a specific
stochastic process (geometric Brownian) for the number of scans performed in a year. An optimal
stopping problem is then solved in a continuous time setting to determine the optimal level of the
stochastic variable that ensures cost-effectiveness respectively for a PET scanner and a PET Centre.
When the provider’s viewpoint is considered, the number of uncertain variables playing a role
becomes larger. The expected value of the project is determined running Monte Carlo simulations in a
discrete time framework. In this context, the value of immediate investment is compared with that of
delayed investment and the value of immediate investment in the bigger project (PET Centre) with that
of a modular investment (investment first in the PET scanner and in the Centre at a later stage).
‡This paper is an extract from the preliminary version of my Phd thesis. I am grateful to my supervisors Rosella
Levaggi and Michele Moretto. I would like to thank the department of Medicine and Public Health of the University
of Verona and in particular Emanuele Torri for fundamental advise on medical aspects. The data have been kindly
provided by the Local Health Authority (ASL) of Verona (Italy).

Pfennig, Andrea
Charite – University Medicine Berlin, Department of Psychiatry and Psychotherapy
Chariteplatz 1, 10117 Berlin, Germany
Telephone: +49 30 450 529 015, Telefax: +49 30 450 529 902
Email: andrea.pfennig@charite.de
Development of a Guideline for Diagnosis and Treatment of Bipolar Disorder
Manic-depressive (bipolar) disorder is a severe psychiatric disease with a lifetime prevalence of 1 to 5
%. Following manifestation in adolescence or early adulthood the long-term course is characterized by
recurrent episodes of mania or hypomania and depression or, not seldom, chronicity. Even in mood
symptom free states, most patients experience residual impairment that increases the risk for
recurrence additionally. Apart from the tremendous individual suffering bipolar disorder imposes the
highest health care and societal costs among the psychiatric disorders. For Germany, estimations
amount to 6 billion Euro per year, to the greatest extent by indirect costs through incapacity for work.
Adequate treatment of bipolar patients is associated with a favourable outcome. However, several
characteristics adversely affect adequate and early medical care. Collaborative care models,
evidence-based guidelines and algorithm-guided treatment offer potential for cost-effective
approaches that reduce the life-long suffering of bipolar patients.
Since there is no evidence-based guideline for diagnosis and treatment of bipolar disorder available in
Germany, in Mai 2005, the German Society for Bipolar Disorders (DGBS) and the German Society for
Psychiatry, Psychotherapy and Neurology (DGPPN) agreed on developing such a guideline. The
three-step developmental process includes enlisting a representative board of medical experts,
patients and organisations, systematic evidence-based information gathering and appraisal and
structured consensus finding. Decision analysis will be used to identify the optimal treatment pathway
to the optimal outcome. The few decision analytical approaches for treatment assessment in bipolar
disorder will be explored for potential usefulness in the German setting (i.e. that of the Department of
Health System Financing, Evidence and Information for Policy (EIP), World Health Organization,
Geneva, Switzerland). Outcome analysis will be planned to assess effects on relevant outcomes
following guideline implementation in Germany. I would like to use the ESF conference to discuss
issues on the decision and outcome analysis as part of the planned guideline with the experts in the
field.

Pliskin, Joseph S.
Ben-Gurion University of the Negev, Health Sciences and Engineering Sciences, Health Systems
Management & Industrial Engineering & Management
653 Beer-Sheva 84105, Israel
Telephone: +972 3 5162035, Telefax: +972 8 6477634
E-Mail: jpliskin@bgu.ac.il
Decision Making in Acquiring Medical Technologies on the Hospital Level
Innovative medical technologies may dramatically improve patient outcomes, but are also one of the
leading causes of increasing healthcare expenditures. The acquisition of new technologies and the
determination of how and when they should be used are amongst the most important administrative
decisions made in the healthcare system in general and by hospital executives in particular, but only a
limited number of studies described the administrative decision-making or strategic technology
planning in hospital management.
Technology adoption decisions in hospitals may occur through planned acquisitions or through
uncontrolled changes in medical practice. They reflect a complex set of dynamics and incentives. A
number of theories have been suggested to describe hospital behavior and adoption of new
technology, yet none of these perspectives alone has been able to satisfactorily explain technology
adoption decisions. The objectives of this paper were to explore the decision-making process in
adopting new technologies at the hospital level. We were interested to assess how accurately
theoretical models describing hospitals’ behavior are reflected in “real world” decisions. We were
particularly interested in understanding the actual considerations that impact the adoption decisions in
various technologies, the information used for this process, and barriers for optimal decision-making.
We found that the most frequent criteria favoring adoption included increased cost-effectiveness,
increased efficacy and decrease in complication rates. An increase in complication rates or side
effects and decreased efficacy were the top ranked criteria against adoption. Participation in scientific
meetings, opinions of local experts, medical journals and FDA clearance documents were the most
important information sources used in the decision-making process. However, these were not
necessarily the optimal sources of information. Significant barriers in adoption decision-making are
lack of timely data regarding the safety of the new technology, its cost-effectiveness and efficacy. We
conclude that in order to improve the adoption decisions, hospitals must develop criteria upon which
the decision-making will be based.

Propping, Peter
University of Bonn, Institute of Human Genetics
Wilhelmstr. 31, 53111 Bonn, Germany
Telephone: +49 228 287 2346, Telefax: +49 228 287 2380
Email: propping@uni-bonn.de
Genetic Testing and Medical Decision Making
The sequence of the nucleotides (“genetic letters”) within the human genome has been deciphered. It
turned out that within the 3,2 billion nucleotides of an individual genome there exists a certain
variation. About one in one thousand nucleotides is variable amounting to approximately three millions
variants within each genome. Since humans are diploid organisms we possess two genomes. Thus,
each of us possesses about four to five millions of variants, either in the homozygous or the
heterozygous state. Although only part of these variants has functional consequences, it can be
concluded that all the inherited differences between humans including genetic diseases and disease
predispositions must be encoded in the genetic variants.
If a variant within the human genome has severe functional consequences a monogenic (dominant or
recessive) disease results. So far, for about 2.000 monogenic diseases the genetic basis has been
uncovered. Most monogenic diseases are rare. The diseases which are common in the human
population have a multifactorial basis. In these diseases a pattern of genetic variants in combination
with environmental factors are necessary for the development of the disease. Examples are diabetes
mellitus, hypertension, atherosclerosis, or mental diseases. It will be a huge challenge not only for
human genetics but for the whole field of biomedicine to pin down the genetic basis of the
multifactorial diseases in the next decades. Once this goal has been achieved great chances for
disease prevention and rational therapeutic approaches will emerge.
The rationale of the application of genetics for disease prevention is predictive testing. In the future
people may be systematically tested for genetic variants that predispose to diseases for which
preventive options exist. Once such a predisposing variant or even a pattern of predisposing variants
has been uncovered in an individual, he or she should apply a systematic prevention program.
Within the next decade high through-put and fast sequencing methods that can be applied at
affordable costs will be developed that allow the detection of high numbers of variants. There is even
the possibility that the whole genome of an individual can be sequenced within a short time and at
affordable costs. Admittedly, a major bottleneck will be to identify the functional consequences of the
millions of existing variants. It will be a challenge for the whole biomedical field to characterize the
meaning of all these variants.
Another drawback is the psychological dimension. People may prefer not to know their disease
predispositions, because they are afraid of a psychological burden. For only part of the disease
predispositions a preventive strategy will be available. Therefore, a structured information and
counseling program is necessary. Certainly, an over-the-counter offer of genetic testing is not suited.
The presentation will be divided into four parts:
1. Basics of genetic variation, genetic testing and its relevance for diagnosis of diseases.
2. Future possibilities of genetic testing and its implications for disease prevention.
3. The psychological limitations of genetic testing and practical applications.
4. The need for a structured information and support program.

Reese, Jens Peter
University of Marburg, Klinik für Neurologie
Rudolf Bultmann Strasse 8, 35039 Marburg, Germany
Telephone: +49 6422 899336
Email: reese@staff.uni-marburg.de
Factors Associated with the Willingness to Participate in Clinical Trials of Patients
with Parkinson’s Disease
Reese, J.-P., Barone, P., Melamed, E., Leenders, K.L., Lees, A., Oertel, W.H., Poewe, W., Rascol, O., Ruzicka,
E. , Tolosa, E., Sampaio, C. - European network for Parkinson’s disease (EuroPa) steering group
Purpose
Recruitment of qualified patients is one of the most costly and time consuming processes within the
course of a clinical trial (CT). In the highly researched field of Parkinson’s disease (PD) no study about
the willingness to participate of PD patients has been undertaken up to now. To gain information
advantage towards a more efficient CT planning we evaluated factors that may predict patients’
willingness to participate in CTs.
Methods
We used the minimal data set of the European cross-sectional survey of data related to Parkinson´s
Disease of the EuroPa data base including records from 10 European neurological centres. In
univariate analyses and a multivariate logistic regression model we tested for correlations between the
willingness to participate in CTs and clinical and demographic factors.
Results
Of 1,280 respondents, 80.1% were willing to participate in clinical trials; about 17 % annually
participated in a CT. There were significant positive correlations between willingness to participate and
younger age groups (< 55 years odds ratio (OR), 4.82; 55-65 years OR, 3.56; 65 -75 years OR, 2.04,
each P 75 years. Male gender is positively associated with
willingness to participate (OR 1.73, P

Roberts, Mark S.
Associate Professor of Medicine, Health Policy and Management and Industrial Engineering
Chief, Section of Decision Sciences and Clinical Systems Modeling
Department of Medicine, University of Pittsburgh School of Medicine
200 Meyran Avenue, 2 nd Floor, Pittsburgh, PA 15213, United States
Telephone: +1 412 692 4826, Telefax: +1 412 246 6954
Email: robertsm@upmc.edu
The Efficient Allocation of Organ Transplants
Organs for transplantation are a scarce resource for which demand greatly exceeds supply. The
United States has developed a method of allocating organs to potential recipients that attempts to
balance efficiency, equity and yet maintain some local and regional autonomy and incorporates the
concept that organs should be allocated to those who are sickest first. The current allocation scheme
has produced significant variations in waiting times by region of the country, and it is not clear that the
current allocation scheme makes maximal use of the limited resource. We describe the development
and calibration of a discrete event simulation model of the US organ allocation system to predict the
outcomes of changes in policy, and describe the effects of policy changes prior to their introduction.

Robins, James M.
Department of Epidemiology, Harvard School of Public Health
677 Huntington Ave., Boston,Ma. 02115, United States
Email: robins@epinet.harvard.edu
Estimation of Optimal Treatment Strategies
Consider observational data on the HIV infected patients receiving their health care at a large HMO. At
each visit on the basis of a patient's treatment, clinical, and laboratory history, the patient's physician
must decide whether to treat with anti-virals and if so the particular drugs and dosages to prescribe. In
this talk, I describe methods for estimation of the optimal - or near optimal treatment strategies - that
maximize or nearly maximize quality adjusted survival time.

Rogowski, Wolf
GSF – National Research Center for Environment and Health, Institute of Health Economics and
Health Care Management
P.O. Box 1129, 85758 Neuherberg, Germany
Telephone: +49 89 3187 4128, Telefax: +49 89 3187 194128
Email: Wolf.Rogowski@gmx.de
Molecular Medicine and individualized Healthcare: Mapping the health economic
evidence
OBJECTIVES: Molecular medicine and individualized healthcare have been claimed to fundamentally
change healthcare. This study investigates to what extent healthcare individualization by human DNA
and RNA technology has been economically assessed.
METHODS: A generic framework was developed to map economic evaluations of treatment individualization
by gene technology. Methodological issues and the current state of economic evidence were
extracted from publications within selected groups of evaluations.
RESULTS: Molecular Medicine and individualized healthcare are fuzzy terms which can be used to
denote a variety of healthcare interventions. A few economic evaluations of diagnostic applications of
gene technology for individualized healthcare were identified. For preventive applications by genetic
predictive testing, the effectiveniss widely remains to be established. Cost-effectiveness evaluations
for pharmacogenetic interventions can usually be based on clinical trial data; the establishment of
cost-effectiveness for preventive interventions in contrary involves a number of highly uncertain assumptions
due to the long time periods spanned by the models.
CONCLUSION: Pharmacogenetic applications in the field of individualized medicine are a young, but
promising field of health economic research. For preventive applications based on widespread predictive
genetic testing, health economic studies generally lack the basis for robust cost-effectiveness
evaluations.

Sander, Beate
University of Toronto, University of Health Network, Department of Clinical Decision-Making and
Health Care Research
200 Elizabeth Street, EN13-239 Toronto, ON M5G 2C4, Canada
Telephone: +1 416 340 4800/6907, Telefax: +1 416 340 4814
Email: bsander@uhnres.utoronto.ca
Time Horizon Bias in Economic Evaluations
Purpose: To systematically evaluate the impact of time horizon choice on the incremental costeffectiveness
ratio under varying assumptions regarding treatment effectiveness, costs and discount
rate.
Methods: A simple Markov model, comparing two hypothetical strategies, was developed. The health
states considered under each strategy are “alive” and “dead”. The model predicts marginal quality
adjusted life years (QALYs), marginal costs and marginal incremental cost-effectiveness ratios (ICER)
as a function of time horizon (ranging from 5 to 50 years). It is assumed that clinical trial data is
available for 5 years of follow up. The model was analyzed for the following scenarios: extrapolation of
survival benefit (continued divergence of survival benefit (optimistic), equal mortality rates at end of
follow up (intermediate), immediate loss of cumulative survival benefit at end of follow up
(conservative)), prediction of treatment costs (one time costs only, e.g. device or surgical therapy,
constant continued incremental cost, e.g. drug therapy, and cost decrease after 10 years), and
discount rate (undiscounted, same discount rate for QALYs and costs, differential discount rate for
QALYs and costs).
Results: In the baseline scenario (equal mortality rates at end of follow up, constant continued
incremental costs, 5% discount rate for costs and effects) incremental costs and incremental QALYs
increase but ICER decreases as the time horizon increases. The effect on ICER is greatest when
comparing a 5 year to a 10 year or longer time horizons. For most scenarios the ICER does not
change as much when extending the time horizon beyond 15 years (less than 20% relative change in
ICER).The choice of time horizon conditional on the extrapolation method of survival benefit (optimistic
and intermediate scenarios) for one time cost scenarios had the greatest impact on reducing the ICER
(reduction of >60% if using 10 year instead of 5 year time horizon). In scenarios with continues costs,
the ICER was sensitive to a cost decrease after 10 years but less sensitive to the chosen discount
rate.
Conclusions: Current guidelines suggest adopting a lifetime time horizon when a mortality benefit is
present. This study measures the bias associated with adopting the time horizon of a clinical trial, a
common practice. Most susceptible to bias are scenarios with one time costs only as the ICER is most
sensitive to the chosen extrapolation method for survival benefits. The choice of time horizon and its
impact on ICER warrant careful consideration when performing economic evaluation, developing
guidance for the evaluation of health technologies and assessing economic evaluations.

Sculpher, Marc
University of York, Centre for Health Economics
Heslinton, York, YO10 5DD, United Kingdom
Telephone: +44 1904 321440, Telefax: +44 1904 321402
Email: mjs23@york.ac.uk
Health Economics for Technology Assessment: A Methods Overview
Economic evaluation now provides a key input into decision making in health care systems. The most
obvious form of this to its use to inform decisions about the reimbursement (or adoption) of new
pharmaceutical technologies but, in less obvious ways, it inputs into a range of resource allocation
decisions. This presentation will provide an overview of economic evaluation methods in health care.
It will explain the key elements of cost-effectiveness analysis and consider three areas in which there
is often a tension between the perspective of the health economist and that of the clinician. The first
area is outcome measurement where the economist’s focus on generic health measurement based on
patients’ perceptions is often misunderstood by clinicians. The second is the role of the randomised
trial which is central to how clinicians see evidence but which has limitations as a vehicle for economic
analysis. The third is the quantification of uncertainty where conventional statistical inference, centred
on p-values, is the clinician’s focus, but it’s role in economic evaluation is limited.

Siebert, Uwe
Harvard Medical School, Professor of Public Health, Chair, Dept. of Public Health, Medical Decision
Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical
Informatics and Technology
Eduard Wallnöfer-Zentrum I, A-6060 Hall i.T., Austria
Telephone: +43 50 8648 3930, Telefax: +43 0 50 8648 673931
Email: uwe.siebert@umit.at
The Use of Decision Analysis in National Health Technology Assessment
Uwe Siebert is Professor of Public Health and Chair of the Department of Public Health, Medical
Decision Making and Health Technology Assessment at the University for Health Sciences, Medical
Informatics and Technology (UMIT) in Hall/Innsbruck, Austria, as well as Associate Professor for
Radiology at the Harvard Medical School in Boston, USA. He has served as Director of the
Cardiovascular Research Program in the Institute for Technology Assessment at the Massachusetts
General Hospital in Boston since 2003.

Sugano, David
VP Global Health Outcomes Strategy, Schering-Plough Corporation
Global Headquarters, Schering-Plough Corporation World Headquarters
2000 Galloping Hill Road, Kenilworth, NJ 07033-0530, United States
Telephone : +1 908-298-7004, Telefax: +1 908-298-4123
Email: janice.lewandowski@spcorp.com
Should Industry Participate in New Health Technology Assessments?
Health technology assessments (HTAs) of new medical products, such as drugs are today being
carried out by various agencies and organizations around the world. The quality of these HTAs vary
widely and are dependent to no small extent on the expertise and level of effort of the participants
engaged in the review. Another factor which may affect the quality of the review is the level of
engagement of the sponsor, who often has the most extensive clinical data and knowledge regarding
proper use of their product. Some HTAs allow virtually no involvement by the product manufacturer in
their review process, while others seek extensive engagement and submissions from sponsors. Even
those that require formal submissions, however, may utilize little or none of the input from such
companies in their final deliberations.
While there is a potential danger in accepting at face value any industry input into an HTA process,
with appropriate expertise and review embedded in the entire appraisal process, the potential for a
broader discussion and hence a more rounded final evaluation may be possible with such participation
in the process. The current FDA Advisory Boards where both company and FDA staff are required to
present can be questioned by the review panel might provide an interesting way to improve current
procedures for engaging sponsors in the HTA process.

Sun, Eric
University of Chicago, Graduate School of Business and Pritzler School of Medicine
899 S Plymouth Ct, no 1104, Chicago, IL 60605, United States
Telephone: +1 301 325 1458, Telefax: +1 773 702 5257
Email: ericsun@uchicago.edu
Product Liability and Medical Markets
While medical lawsuits have received much attention from policymakers and the press, little effort has
been made to theoretically and empirically examine the efficiency of tort reforms. In this paper, I
theoretically examine the efficiency of tort reforms and calibrate the efficiency of a cap on noneconomic
damages in the market for childbirths. Theoretically, I find that when market power exists,
damage caps may enhance welfare by lowering price and increasing output. Moreover, I show that
when firms can enter and exit an industry, the effect of damage caps is magnified, because in addition
to their direct effects on marginal cost, damage caps can induce firms to enter an industry, thereby
reducing the markup over marginal costs. Empirically, I show that hospitals pass on most of the costs
of liability risk to patients. I estimate that a $250,000 cap on non-economic damages would save
consumers $575 million per year (roughly 5% of the expenditures on childbirths), and increase
consumer welfare by $192 million year year (roughly 1.6% of expenditures on childbirths).

Sundmacher, Leonie
University of York
Wentworth Way, Yo105NG York, United Kingdom
Email: sunleo@web.de
The Role of Health Shocks in Quitting Smoking: Evidence from the European
Community Household Panel
The European Union has stated interest in assessing the effectiveness and relevance of its messages
about the adverse consequences of smoking in the context of its tobacco control policy. In the
absence of disaggregated data on the direct relationship between health information and smoking
decisions, we follow Clark et al. (2002) and investigate the impact of health shocks on the probability
to quit daily smoking using eight waves of the European Union Community Household Panel (ECHP).
Our intention is to assess whether individuals learn from changes in health i.e. successfully update
new information about the consequences of tobacco consumption. As self assessed health is
subjective and prone to reporting bias, we instrument self assessed health using “objective" health
indicators and the socio-demographic variable age; the resulting variable is then used to model
continuous and discrete changes in health, termed as health shocks. Estimating a discrete time
hazard model with gamma distributed frailty, we find evidence that objective discrete health shocks
increase the probability to quit daily smoking. Stratifying by gender reveals that in particular men
above 55 quit following a negative health shock while the results for women are not statistically
significant. Assuming that the increased hazard rate for men is associated with an increased perceived
risk of coronary artery disease, we conclude that specific information about smoking related health
shocks are the most effective health warnings.

Taisescu, Citto
University of Medicine and Pharmacy Craiova, Department of Pathopysiology
Str. Petru Rares nr. 2-4, 200349 Craiova, Romania
Email: taisescu@yahoo.com
Romania’s Health Care System – The Financial Perspective and the EU Challenge
Citto Iulian Taisescu - University of Medicine and Pharmacy Craiova
Aanca Tanasie. - Faculty of Economics and Business Administration, University of Craiova
Romania’s European accession represents a real challenge concerning the requirements of the
enlargement process to the East. This involves both the adoption of the “aquis comunitaire” and the
institutional and administrative capabilities needed to implement these legal aspects. This paper is a
study of the Romanian medical system from the financial point of view, of the evolutions and reforms
required in order to achieve compliance with the EU standards. The main actual challenge confronting
the Romanian health system is represented by some major budget constraints and the aim of this
paper is to analyze and offer potential financing opportunities that would ensure the sustainability of
the health care system. In this respect, financing could be also be offered by European structural
instruments and a brief evaluation of these opportunities is achieved. The analysis is based on certain
criteria formulated in order to comprise the key elements of the medical system reform: - financial
sustainability and the impact of the reform on the heath care system budget; - the compliance with the
European standards in the context of the medical systems’ co-ordination; - the feasibility in the
implementation and administration.

Tanasie, Anca
University of Craiova, Faculty of Economics and Business Administration, Department of Economic
Theory
Str. A. I. Cuza nr13, 200349 Craiova, Romania
Email: ancatanasie@central.ucv.ro
Romania’s Health Care System – The Financial Perspective and the EU Challenge
Citto Iulian Taisescu - University of Medicine and Pharmacy Craiova
Aanca Tanasie. - Faculty of Economics and Business Administration, University of Craiova
Romania’s European accession represents a real challenge concerning the requirements of the
enlargement process to the East. This involves both the adoption of the “aquis comunitaire” and the
institutional and administrative capabilities needed to implement these legal aspects. This paper is a
study of the Romanian medical system from the financial point of view, of the evolutions and reforms
required in order to achieve compliance with the EU standards. The main actual challenge confronting
the Romanian health system is represented by some major budget constraints and the aim of this
paper is to analyze and offer potential financing opportunities that would ensure the sustainability of
the health care system. In this respect, financing could be also be offered by European structural
instruments and a brief evaluation of these opportunities is achieved. The analysis is based on certain
criteria formulated in order to comprise the key elements of the medical system reform: - financial
sustainability and the impact of the reform on the heath care system budget; - the compliance with the
European standards in the context of the medical systems’ co-ordination; - the feasibility in the
implementation and administration.

Timmermans, Daniëlle
VU University Medical Center, Faculty of Medicine, Department of Public and Occupational Health
Van der Boechorstraat 7, 1081 BT Amsterdam, Netherlands
Telephone: +32 20 444 8358, Telefax: 31 20 444 8387
E-Mail: drm.timmermans@vumc.nl
Informed Decision Making: Balancing Risks and Benefits?
During the last several decades, the role of patients in health care is changing. The participation of
patients and the general public in the decision making process with regard to the treatment or the
care they receive is increasing. With the increasing trend to patient-focused decision making, the
emphasis is more and more on informed decision making of patients. This idea originated in
biomedical ethics with the notion of informed consent as an attempt to safeguard patients'
autonomy. Informed consent in biomedical ethics usually means a voluntary uncoerced decision,
made by competent autonomous persons who are capable of informed decision-making and can
communicate their wishes. Practice might be different, however. A relevant question to ask is “Are
people capable of making informed decisions?”.
An informed decision should be based on adequate information and deliberation. Competent
patients are assumed to be able to adequately appraise all the risks involved, and to have stable
values they can communicate to a health professional. Behavioural decision research, however, has
shown that there are cognitive limitations to informed (and rational) decision making. To what extent
are people capable of adequately appraising risks and benefits? Do people have stable preferences
and values? And what does this mean for informed decision making? When is a decision an
informed decision and who decides whether this is the case or not? These questions are even more
pertinent given the possibilities as a result of advances in, e.g. genomics, leading to individually
determined health risks. In this presentation I will discuss some of the limitations in informed
decision making illustrated by data from own research, and the implications for the concept of
informed decision making.

Vansteelandt, Stijn
Ghent University, Applied Mathematics and Computer Science
Address: Krijgslaan 281, S9, 9000 Ghent, Belgium
E-Mail: stijn.vansteelandt@ugent.be
Gene-environment Interaction in Family-based studies
This presentation reflects joint work with Christoph Lange (Harvard University).
We propose robust and efficient tests and estimators for gene-environment/gene-drug interactions in
family-based association studies. The methodology is designed for studies in which haplotypes,
quantitative phenotypes and complex exposure/treatment variables are analyzed. Using causal
inference methodology, we derive family-based as-sociation tests and estimators for the genetic main
effects and the interactions. The tests and estimators are robust against population admixture and
stratification without requiring adjustment for confounding variables. We illustrate the practical
relevance of our approach by an application to a COPD study. The data analysis suggests a geneenvironment
interaction between a SNP in the Serpine gene and smoking status/pack years of
smoking. Simulation studies show that the proposed methodology is sufficiently powered for realistic
sample sizes and that it provides valid tests and effect size estimators in the presence of admixture
and stratification.

Zweifel, Peter
Socioeconomic Institute, University of Zurich
Hottingerstrasse 10, CH-8032 Zurich, Switzerland
Telephone : +41 1 634 37 20, Telefax +41 1 634 49 87
e-mail: pzweifel@soi.unizh.ch
Insurance and the Diffusion of Medical Innovation – A Case of Interdependence
For health insurers and policy makers, technological change in medicine and its diffusion are an
influence from the outside that threatens to drive up health care expenditure (HCE). This contribution
challenges this notion by pointing to the fact that pace and diffusion of medical technology is strongly
influenced by health insurance and indirectly, public provision for old age.
Its point of departure is a puzzle. Why is it that technological is considered to be cost increasing in
health but an important source of cost savings in the remainder of the economy? The answer to this
question seems to lie in the incentive effects of health insurance, and indirectly, the present-day
design of provision of old age. This raises the question of how (if at all) new medical technology should
be managed. The contribution ends on a cautionary note, citing recent evidence suggesting that
consumers' preferences are strongly in favor of immediate access to medical innovation, measured by
substantial have a substantial willingness-to-pay values.

List of Participants
Adghoughi, Rachid ESF Conference Secretary
Aidelsburger, Pamela
Aider, Jean-Luc
Begum, House Ara University of Dhaka, Institute of Health Economics, Bangladesh
Bischof, Matthias University of Basel, Institute for Clinical Epidemiology and Swiss
Tropical Institute, Switzerland
Bleichrodt, Han Erasmus University, Faculty of Economics, Department of Applied
Economics, Netherlands
Bosch, Johanna L. Erasmus Medical Centre, Dept. Of Epidemiology and Biostatistics,
ART group, Netherlands
Bridges, John F.P. Assistant Professor, Department of Health Policy & Management, J
ohns Hopkins Bloomberg School of Public Health, United States
Briggs, Andrew University of Glasgow, Department of Public Health & Health Policy,
United Kingdom
Brixner, Diana I. University of Utah, Associate Professor and Chair, Department of
Pharmacotherapy, Executive Director Pharmacotherapy Outcomes
Research Center, President Elect International Society of
Pharmacoeconomics and Outcomes Research 2006-2007, United
States
Bruhn, Thomas European Medical Research Councils
Brus, Helena R. Merck & Co. Inc., United States
Bux, Iqram South African Military Health Service, South Africa
Carlsson, Per National Centre for Priority Setting in Health Care, Sweden
Carrera, Percivil M. University of Heidelberg, Medical School, Department of Tropical
Hygiene and Public Health, Junior Group International Health
Economics and Outcome Research, Germany
Claxton, Karl Assistant Professor of Health and Decision Sciences, Harvard School
of Public Health; Senior Lecturer in the Department of Economics and
Related Studies at the University of York; Member, National Institute
for Health and Clinical Excellence Appraisal Committee, Centre for
Health Economics, University of York, United Kingdom
Dauben, Hans-Peter Deutsches Institut für Medizinische Dokumentation und Information,
Germany
Detmer, Don E. University of Virginia, Charlottesville; President/CEO, American
Medical Informatics Association, United States

Diez, Francisco Javier UNED, Universidad Nacional de Educación a Distancia, ETSI
Informatica, Research Center on Intelligent Decision-Support
Systems, Spain
Dintsios, Charalabos-Markos Institute for Quality and Efficiency in Health Care associated
with Hannover Medical Department of Epidemiology, Social
Medicine & Health Systems Research, Germany
Eeckhoudt, Louis FUCAM, Facultes Universitaires Catholiques de Mons, Université
Catholique de Lille and Center for Operations Research and
Econometrics at Louvain-la-Neuve, Belgium
Fliedner, Juliane University of Freiburg, Institute for Economic Policy Research,
Department of International Economic Policy, Germany
Fitzpatrick, Stephen Alfred Hospital, Bayside Health, Melbourne, Australia
Fuchs, Sabine
Furtmayr, Ludwig
Gandjour, Afschin University of Cologne, Department of Health Economics and Clinical
Epidemiology, Germany
García-Barbero, Milagos Head Office, WHO European Office for Integrated Health Care
Services, Spain
Gelijns, Annetine C. Professor of Surgical Science and Public Health, Co-Director,
International Center for Health Outcomes and Innovation Research,
Columbia University, New York, United States
Göhler, Alexander Massachusetts General Hospital, Harvard University, Faculty of
Medical School and School of Public Health, Institute for Technology
Assessment, United States
Halamová, Dáša University of P. J Safarik, Faculty of Natural Science, Department of
Inorganic Chemistry, Slovak Republic
Hammitt, James K. Professor of Economics and Decision Sciences; Director, Harvard
Center for Risk Analysis, Harvard University, School of Public Health,
United States
Herholz, Karl University of Manchester, Faculty of Medicine; Director, Wolfson
Molecular Imaging Centre, United Kingdom
Holle, Rolf GSF – Research Centre for Environment and Health, Intitute of Health
Economics and Health Care Management (IGM), Germany
Hostenkamp, Giesela Kiel Institute for the World Economy, Global Health Economy,
Germany
Hoyle, Nicholas Roche Diagnostics GmbH, Germany
Ispas, Ioana Rodica EU Advisor for Bioethics,Genomics and Health, Ministry of Education
and Research, European Integration and International Cooperation
Division, Romania
Jena, Anupam B. University of Chicago, Department of Economics and School of
Medicine, United States

John, Jürgen GSF National Research Center for Environment and Health, Institute
of Health Economics and Health Care Management, Germany
Kapeniece, Andra Riga Stradina University, Clinical Hospital “Gailezers”, Latvia
Kireitseu, Maksim University of Sheffield, Faculty of Future Generation Materials, Kroto
Research Institute, United Kingdom
Kollek, Regine University of Hamburg, Research Centre for Biotechnology, Society
and the Environment, Germany
Körfer, Reiner Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax-
und Kardiovaskularchirurgie, Germany
Krauth, Christian Hannover Medical School, Department of Epidemiology, Social
Medicine and Health Systems Research, Germany
Levin, Llars-Åke Center for Medical technology Assessment, University of Linköping,
Sweden
Lindholm, Torun Mälardalen University, Department of Social Sciences, Sweden
Loukanova, Svetla University of Heidelberg, Health Economics and Outcome Research,
Germany
Lühmann, Dagmar Universitätsklinikum Schleswig-Holstein, Institute of Social Medicine,
Germany
Magnezi, Rachel Ariell College, School of Health Science, Department of Health
Systems Management, Isreal
Marckmann, Georg University of Tübingen, Department of Medical Ethics, Germany
Martín-Sanchez, Fernando Head of the Medical Bioinformatics Department, National Institute of
Health Carlos III, Spain
Meltzer, David Center for Health and the Social Sciences, Department of Medicine,
Department of Economics, and Harris Graduate School of Public
Policy Studies, University of Chicago, United States
Mihalas, George I. Victor Babes University of Medicine and Pharmacy; President,
European Federation of Medical Informatics (EFMI), Romania
Obermann, Konrad University of Applied Sciences of the German Red Cross, Germany
Paiziev, Adkhamjon Academy of Science of Uzbekistan, Department of Applied Physics,
Uzbekistan
Pandey, Ugrasen Agra University, S.R.K.P.G. College, Department of Sociology, India
Pertile, Paolo Catholic University Milan, Graduate School in the Economics and
Finance of Public Administration (DEFAP), Italy
Pfennig, Andrea Charite – University Medicine Berlin, Department of Psychiatry and
Psychotherapy, Germany
Pliskin, Joseph S. Ben-Gurion University of the Negev, Health Sciences and Engineering
Sciences, Health Systems Management & Industrial Engineering &
Management, Israel
Propping, Peter University of Bonn, Institute of Human Genetics, Germany

Raspe, Heiner Universitätsklinikum Schleswig-Holstein, Institute of Social Medicine,
Germany
Reese, Jens Peter University of Marburg, Klinik für Neurologie, Germany
Roberts, Mark S. Associate Professor of Medicine, Health Policy and Management and
Industrial Engineering, Chief, Section of Decision Sciences and
Clinical Systems Modeling, Department of Medicine, University of
Pittsburgh School of Medicine, United States
Robins, James M. Department of Epidemiology, Harvard School of Public Health, United
States
Rogowski, Wolf GSF – National Research Center for Environment and Health, Institute
of Health Economics and Health Care Management, Germany
Sander, Beate University of Toronto, University of Health Network, Department of
Clinical Decision-Making and Health Care Research, Canada
Schmidt, Ulrich University of Kiel, Institut für Volkswirtschaftslehre, Germany
Schulenburg, J.-Matthias University of Hannover, Germany
Scott, Ian H.K. National Clinical Lead Hospital Doctors, NHS Connecting for Health,
Medical Director, Ipswich Hospital NHS Trust, United Kingdom
Sculpher, Marc University of York, Centre for Health Economics, United Kingdom
Siebert, Uwe Harvard Medical School, Professor of Public Health, Chair, Dept. of
Public Health, Medical Decision Making and Health Technology
Assessment, UMIT - University for Health Sciences, Medical
Informatics and Technology, Austria
Simon, Daniela University Hospital of Freiburg, Department of Clinical Epidemiology
and Health Service Research, Germany
Stolpe, Michael Kiel Institute for the World Economy; Head, The Global Health
Economy, Germany
Storz, Philipp
Sugano, David VP Global Health Outcomes Strategy, Schering-Plough Corporation
Global Headquarters, United States
Sun, Eric University of Chicago, Graduate School of Business and Pritzler
School of Medicine, United States
Sundmacher, Leonie University of York, United Kingdom
Taisescu, Citto University of Medicine and Pharmacy Craiova, Department of
Pathophysiology, Romania
Tanasie, Anca University of Craiova, Faculty of Economics and Business
Administration, Department of Economic Theory, Romania
Timmermans, Daniëlle VU University Medical Center, Faculty of Medicine, Department of
Public and Occupational Health, Netherlands
Vansteelandt, Stijn Ghent University, Applied Mathematics and Computer Science,
Belgium

Vietor, Christine Techniker Krankenkasse, Germany
Wahler, Steffen Verband der forschenden Arzneimittelhersteller, Germany
Yfantopoulos, John Standing Committee for the Social Sciences at the European Science
Foundation
Zweifel, Peter Socioeconomic Institute, University of Zurich, Switzerland
Guests for the Reception October 5, 2006:
Grönewald, Heiner Direktor Marksegment Gesundheitswesen, ORGA Kartensysteme
GmbH Germany
Körner, Hellmut Staatssekretär, Ministerium für Soziales, Gesundheit, Familie, Jugend
und Senioren, Schleswig-Holstein, Germany
Lehmann, Randy Gesundheitsinitiative, Ministerium für Soziales, Gesundheit, Familie,
Jugend und Senioren, Schleswig-Holstein, Germany
Snower, Dennis President, Kiel Institute for the World Economy, Germany

ESF Research Conferences
A Programme of the European Science Foundation
Final
Programme
With support from
Institut für Weltwirtschaft an der Universität Kiel
ESF-IfW Conference on The Global Health Economy
New Technology and Medical Decision Making
Normative Models and Empirical Practice
Salzau Castle (near Kiel) � Germany � 4 - 9 October 2006
Chair: Uwe Siebert � UMIT, Hall, AT & Harvard Medical School, Boston, US
Co-Chair: Peter Zweifel � University of Zürich, CH
www.esf.org/conferences/sc06219
Fritz Thyssen Stiftung State Government of Schleswig-Holstein

Wednes
day
4
October
Thursday
5
October
10.00 – 18.45 Pre-conference Workshops, organized by the Kiel Institute’s Public Policy Center
16.00 onwards Registration at ESF-RC desk
20.00 Dinner
21.00 Welcome Drink
08.45 – 09.00 Conference Opening
Uwe Siebert • UMIT, Hall, AT & Harvard Medical School, Boston, US & Peter Zweifel • University of Zürich, CH
Session 1 • Trends in Medical Technology – Focusing Devices, Technological Trajectories, and Forecasting
Chairs: Annetine C. Gelijns � Columbia University, New York, US – Georg Marckmann � University of Tübingen, DE
09.00 – 09.35 Annetine C. Gelijns • Columbia University, New York, US The Evolution of Medical Technology
09.35 – 10.10 Karl Herholz • University of Manchester, UK Trends in Medical Imaging and their Potential Impact on Diagnosis and Treatment
10.10 – 10.45 Peter Propping • University of Bonn, National Bioethics
Council of Germany, DE
10.45 – 11.15 Coffee break
Genetic Testing and Medical Decision Making
11.15 – 11.50 Reiner Körfer • University of Bochum, DE Trends in Transplantation Technology
11.50 – 12.25 Georg Marckmann • University of Tübingen, DE Ethical Limits of Modern Medical Technology
Session 2 • The Science of Medical Decision Making – Producing & Using Information for Efficient Risk
Management
Chair: Peter Zweifel � University of Zürich, CH
12.25 – 13.00 Mark Sculpher • University of York, UK Decision Analysis as a Basis for Estimating Cost-effectiveness: The Experience of
the National Institute for Health and Clinical Excellence in the UK
13.00 Lunch
14.00 – 14.35 Louis Eeckhoudt • Facultes Universitaires Catholiques de
Mons, Université Catholique de Lille and Center for Operations
Research and Econometrics at Louvain-la-Neuve, BE
14.35 – 15.10 Han Bleichrodt • Erasmus University, Rotterdam, NL The Optimal Management of Co-morbidities and Related Risk
The Management of Risk and Uncertainty in Medical Decision Making
15.10 – 15.45 Mark S. Roberts • Pittsburgh School of Medicine, US The Efficient Allocation of Organ Transplants
15.45 – 16.00 Coffee break
16.00 – 16.35 Danielle Timmermans • University of Amsterdam, NL Informed Decision Making under Technological Change
16.35 – 17.10 Torun Lindholm • Stockholm University, SE Group Membership and Medical Decision Making
17.10 – 17.45 James K. Hammitt • Harvard Center for Risk Analysis,
Boston, US, and Université Toulouse I Sciences Sociales, FR
Short Oral Presentation
Economic and Health Utility Measures in the Evaluation of Patients’ Preferences for
Health Risks and Outcomes
17.45 – 18:10 Paolo Pertile • Catholic University Milan, IT An Extension of the Real Option Approach to the Evaluation of Health Care
Technologies: The Case of Positron Emission Tomography

Friday
6
October
Saturday
7
October
18:30 Reception with Representatives from Schleswig-Holstein’s State Government and the Initiativkreis Gesundheit
Welcome Addresses by Dennis J. Snower, President of the Kiel Institute for the World Economy,
Hellmut Körner, Secretary of State for Health Policy and Social Affairs in Schleswig-Holstein, and
John Yfantopoulous, Standing Committee for the Social Sciences at the European Science Foundation
19:00 Dinner
21.00 Poster Session
Session 3 • Medical Infrastructure, Insurance, and the Diffusion of Innovations
Chairs: Karl Claxton � University of York, UK & Harvard School of Public Health, US - Joseph S. Pliskin � Ben-Gurion University of the Negev, IL
09.00 – 09.35 Karl Claxton • University of York, UK, and Harvard School of
Public Health, Boston, US
Value of Information Analysis: Implications for Research Priorities, Efficient Research
Design and Regulation
09.35 – 10.10 David O. Meltzer • University of Chicago, US Diffusion of Innovations through Social Networks and the Origins of Medical Practice
Variation
10.10 – 10.45 Don E. Detmer • University of Virginia, American Medical
Informatics Association, US
10.45 – 11.15 Coffee break
11.15 – 11.50 Milagos García-Barbero • WHO European Office for
Integrated Health Care Services, Barcelona, ES
11.50 – 12.25 Fernando Martín-Sanchez • Institute of Health
“Carlos III”, Madrid, ES
12.25 – 13.00 George I. Mihalas • Victor Babes University of Medicine
and Pharmacy, European Federation for Medical Informatics, RO
13.00 Lunch
The Information Structure for Effective Evidence-based Medical Decision Making
The eHealth Strategy of the WHO: Problems and Prospects
14.00 – 18.00 Excursion to the city of Lübeck, a UNESCO world cultural heritage site
19.30 Dinner
21.00 Poster Session
Molecular Medicine and Individualized Healthcare: Defining the Research Agenda
How Can Computer Simulations of Biological Processes Support Medical Decision
Making?
Session 3 (continued)
Chairs: Karl Claxton � University of York, UK & Harvard School of Public Health, US - Joseph S. Pliskin � Ben-Gurion University of the Negev, IL
09.00 – 09.35 Peter Zweifel • University of Zürich, CH Insurance and the Diffusion of Medical Innovation – A Case of Interdependence
09.35 – 10.10 Joseph S. Pliskin • Ben-Gurion University of the Negev, IL
Decision Making in Acquiring Medical Technologies on the Hospital Level

Saturday, October 7
Short Oral Presentation
10.10 – 10.35 Percivil Carrera • University of Heidelberg, DE Post-Unification Health Reforms in Germany: The Evolutionary Approach to Reforms
and its Impact on Innovation
10:35 – 11.00 Coffee break
Session 4 • Methods for Estimating the Causal Effect of Medical Interventions from Observational Data
Chairs: James M. Robins � Harvard School of Public Health, US - Stijn Vansteelandt � University of Ghent, BE
11.00 – 11.40 James M. Robins • Harvard School of Public Health,
Boston, US
Methodological Approaches to Adjust for Time-Varying Confounding
11.40 – 12.20 Diana I. Brixner • University of Utah, Salt Lake City, US Using Large Medical Claims Databases to Determine the Economic Effect of
Diseases
12.20 – 13.00 Stijn Vansteelandt • University of Ghent, BE Gene-environment Interaction in Family-based Studies
13.00 Lunch
Short Oral Presentation
14.30 – 14.55 Francisco Javier Diez • UNED, Universidad Nacional de
Educación a Distancia, Madrid, ES
Session 5 • Priority Setting, Health Technology Assessment, and Research Investments
Chair: Michael Stolpe • Kiel Institute for the World Economy, DE
14.55 – 15.30 Uwe Siebert • UMIT, Hall/Innsbruck, AT, and Harvard
Medical School, Boston, US
15.30 – 16.05 Regine Kollek • University of Hamburg, National Bioethics
Council of Germany, DE
16.05 – 16.35 Coffee break
Probabilistic Graphical Models for Medical Decision Making
The Use of Decision Analysis in National Health Technology Assessment
The Subjective Value of Genetic Information: Ethical and Social Considerations in the
Evaluation of Genetic Testing Technologies
16.35 – 17.10 Johanna L. Bosch • Erasmus University, Rotterdam, NL Assessing Technologies for the Treatment of Cardiovascular Disease
Short Oral Presentations
17.10 – 17.35 Alexander Göhler • Harvard School of Public Health and
Massachusetts General Hospital, Boston, US
17.35 – 18.00 Jürgen John • GSF National Research Center for
Environment and Health, DE
18.00 – 18.25 Rolf Holle • GSF National Research Center for Environment
and Health, DE
19.00 Dinner
Decision-analytic Evaluation of the Clinical Effectiveness of Disease Management
Programs in Congestive Heart Failure in Germany
Is Efficiency an Ethically Defendable Criterion for Allocation Decisions in Health
Care?
The Pros and Cons of Threshold Values in Economic Evaluation

Sunday
8
October
Monday
9
October
Session 5 continued • Priority Setting, Health Technology Assessment, and Research Investments
Chair: Michael Stolpe � Kiel Institute for the World Economy, DE
09.00 – 09.40 Andrew Briggs • University of Glasgow, UK Handling Uncertainty in Health Economic Evaluations
09.40 – 10.20 Dagmar Lühmann and Heiner Raspe • University
of Lübeck, DE
10:20 – 11:00 John F.P. Bridges • Johns Hopkins University, Baltimore,
US
Ethical Considerations in Health Technology Assessment in Germany
The Impact of Health Technology Assessments on the Timing of Market Access and
Technology Adoption
11.00 – 11.30 Coffee break
Short Oral Presentations
11:30 – 11:55 Per Carlsson • National Centre for Priority Setting in Health
Care, Linköping, SE
National Guidelines for Heart Diseases – A Model for Open Priority Setting in
Sweden
11:55 – 12:20 Afschin Gandjour • University of Cologne, DE Priority Setting of Investments that Enhance the Adoption of Health Technologies
12:20 – 12:45 Anupam B. Jena • University of Chicago, US The Macroeconomic Value of Life
13:00 – 14:30 Lunch
14.30 – 14.55 Beate Sander • University of Toronto, CA Time Horizon Bias in Economic Evaluations
14.55 – 15:20 David S. Sugano • Schering-Plough, US Should Industry Participate in New Health Technology Assessments?
15.30 – 17.15 Panel Discussion on
“New Technology and Medical Decision Making: Ethics, Incentives, Regulation, and the Role of Health Policy”
with Speakers from the Conference and High-level Representatives from Health Policy, Biomedical Industry, and
Health Care Practice in Germany
Moderator: J.-Matthias Graf von der Schulenburg • University of Hannover, DE
Panelists: Hans-Peter Dauben • Deutsches Institut für Medizinische Dokumentation und Information, Cologne, DE
Don E. Detmer • University of Virginia, American Medical Informatics Association, US
David O. Meltzer • University of Chicago, US
Joseph S. Pliskin • Ben-Gurion University of the Negev, IL
Ian H.K. Scott • National Clinical Lead Hospital Doctors, NHS Connecting for Health, UK
Steffen Wahler • Verband der forschenden Arneimittelhersteller, Berlin, DE
17.15 – 17:45 Coffee break
17.45 – 18.45 Forward Look Plenary Discussion & Conference Closing Session
19:30 Get-together & Conference Dinner
9:00 Breakfast and Departure