Evidence-Based to Value-Based Medicine

Book Review Evidence-Based to Value-Based Medicine, by Melissa M. Brown, Gary C. Brown, and Sanjay Sharma, 339 pp, with illus, $64.95, 515 North State St, Chicago, IL 60610, AMA Press (telephone: 800-621-8335), 2005, ISBN 1-57947-625-2 Type and Scope of Book: This broad-ranging primer on evidence-based medicine and cost-utility analysis explains why the latter must be done along with the former. Contents: In less than 300 pages plus references, the authors introduce readers to principles of evidence-based medicine, health economics, and cost-utility analysis. Coverage of utility assessment, especially time-tradeoff techniques, and discounting is thorough. The authors postulate that evidence-based medicine is not enough and that pa tient prefer ences costs and must be incorporated into medical decision making in order to achieve their ideal—value-based medicine. The mechanics of cost analyses are covered briefly, ending in a step-by-step guide to cost-utility analysis. Additional material on valuebased nursing and pharmacoeconomics appears near the end of the text. The authors express their opinions, many of which differ considerably from commonly accepted concepts of medical decision making, clearly and strongly. The references are extensive. The authors assume their readers have no background in evidence-based medicine or cost-utility analysis. Strengths: The writing is clear. The format of the book highlights key points, and the layout clearly delineates transitions in the text. Appropriate tables and figures effectively supplement the volume. The information on utility assessment and discounting would be hard to find elsewhere in a book for clinicians. Much material is covered in this short book, making it attractive for busy clinicians. Deficiencies: The chapters on health economics, value-based nursing, and pharmacoeconomics are peripheral to the book’s core message. The authors have opted for breadth over depth, and some of the material is covered in a manner that may be difficult for novices to understand adequately. Some tables, especially in chapter 7, would have been better as appendixes. There is more polemic here than many readers will care for. Recommended Readership: Students, residents, fellows, and attending physicians interested in a quick, readable introduction to cost-utility analysis and evidence-based medicine. Overall Grading: ### Mark Liebow, MD, Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn

Grading Key ★★★★★ = outstanding; ★★★★ = excellent; ★★★ = good; ★★ = fair; ★ = poor. © 2005 Mayo Foundation for Medical Education and Research

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