In economics as well as medicine prevention is better than cure

217 EDITORIALS In economics as well as medicine prevention is better than cure Health technology assessment is a difWcult business. Decision making in health care must be evidence-based but then the opportunity cost of waiting for perfect evidence is the beneWt foregone from earlier adoption of a technology. In the UK the National Institute for Clinical Excellence (NICE) was established to weigh the available evidence for health technologies and provide guidance for health care decision-makers. Recent developments in health economic evaluation allow analysts to quantify the uncertainty around decisions based on cost-effectiveness results and calculate the expected value of perfect information (EVPI) [1]. EVPI can guide R&D resource allocation by comparing the value and the costs of seeking better (more certain) information about key parameters in any decision. If the level of uncertainty around a decision is unacceptable to a decision maker given current evidence and the value of additional information greater than the cost of obtaining it then the decision maker may be justi-Wed in postponing adoption of a new technology. On the topic of pressure ulcers this scientiWc approach to decision-making may be viewed by many as a sledgehammer to crush a walnut. Pressure ulcers (also commonly referred to as pressure sores, bed sores, pressure damage, pressure injuries and decubitus ulcers) are areas of localised damage to the skin, which can extend to underlying structures such as muscle and bone. Damage is believed to be caused by a combination of factors including pressure, shear forces, friction and moisture. Pressure damage in adults usually occurs over bony prominences, such as the sacrum. Pressure ulcers are more likely to occur in those who: are seriously ill; are neurologically compromised; have impaired mobility (including those wearing a prosthesis, body brace or plaster cast); suffer from impaired nutrition, obesity or poor posture; or use equipment such as seating or beds that does not provide appropriate pressure relief. Most health care professionals working with elderly patients are more than aware of the pain and discomfort pressure ulcers can cause to individuals, how they can prolong hospital stays and how they can lead to more serious complications and even death. They will also be aware of numerous strategies to avoid pressure ulcers occurring. What then are decision-makers waiting for? Of course the problem is scarcity of resources. Finite budgets have to deal with competing claims. Decision-makers are tasked with maximising what we (society) get …