By Jackie Green, Jane South
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1. Green refers to this decay in impact over time as the backsliding effect. He also identifies three additional time-dependent effects: • Borrowing from the future or trigger effect. The effect of a programme may be overestimated if it initiates change that would have happened anyway. The intervention merely brings forward or hastens change. 1, if those attending for screening are those who would have attended in the reasonably near future anyway, the initial gains may be offset by a reduction in attendance at a later point, leading to a reduced or even zero net effect.
On the basis of this comparison, the lower-cost option can be identified. • Cost-effectiveness analysis. The costs of the programme are quantified in monetary terms and the benefits are identified, ideally as some quantifiable unit such as reduced incidence of a disease or number of life years saved, although no monetary value is assigned to these. 3. For example, within the field of smoking cessation, the cost of providing nicotine replacement therapy per person giving up smoking for 1 year or more could be compared with the cost of general practitioners providing advice to stop smoking during normal consultations per person giving up smoking for 1 year or more.
7). 7 Deficiencies of drug trials (Editor BMJ 1998) Too small Too short Poor quality Poorly presented Methodological inadequacies Few include adequate measures of quality of life Cost data poorly presented Ethical aspects often neglected Views of participants are either not sought or forgotten Participants often have limited understanding of what is happening Poorly managed Politics can hijack conclusions Marketeers can use trials for their own ends Control groups In relation to the feasibility of using experimental design, it should be recognized that public health and health promotion interventions are fundamentally different from clinical interventions.