Health care consumes a large and growing share of the gross domestic product in the United States and other developed nations, and as changes occur in the way health care is provided and financed, clinicians have come under increased scrutiny to control costs and curtail indiscriminate resource use. In the past, physicians and other providers were generally only concerned about individual patients and usually faced decisions which were only limited to this perspective; however, clinicians have been forced to become increasingly concerned with issues that affect groups of patients and must often grapple with decisions that, directly and indirectly, concern resource allocation and economic impact. In the inpatient setting, for example, a physician may sit on committees that determine a hospital's antibiotic formulary or may be required to make recommendations concerning the choice of a thrombolytic agent for the treatment of an acute myocardial infarction. On a broader scale, a physician may serve as the medical director of a managed care organization or as an advisor to a regulatory agency and be responsible for decisions that affect thousands or more patients. Finally, economic analyses are increasingly published in the medical literature; recent estimations have stated that over 100 cost-effectiveness analyses are published each year in the medical literature, a figure that has steadily grown over the past decade.<sup>10 Gold M.E., Siegel J.E., Russel L.B. , et al.   Cost-effectiveness in Health and Medicine New York: Oxford University Press (1996). 

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Clearly, these issues of fair allocation and reasoned distribution require familiarity with the basic techniques of economic analysis and related quantitative methods. Clinical decisions often require an evidence-based approach to ensure that decisions are reached on the basis of sound scientific evidence and reasoning to avoid the pitfalls of anecdotal recall and unsubstantiated empiricism. Economic decisions and decisions regarding program selection and health care planning need to follow a similar standardized rigor according to an accepted methodologic norm. Just as the reliance upon insufficient, unsubstantiated evidence in concert with unproven clinical opinion often leads to substandard diagnostic and therapeutic choices, the use of haphazard and random criteria also leads to inefficient and inequitable allocation and expenditure of resources, with suboptimal and submaximal clinical yield.