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This paper critically evaluates methods for the preliminary economic evaluation of health technologies and the prioritization of health technology assessment projects. It reports on the literature, and considers methods currently employed and the purposes of preliminary appraisal. It concludes that a preliminary economic appraisal needs to be applied to the two main stages of the prioritization process; to have transparent criteria; to allow for an appropriate range of potential outcomes; to be practicable, flexible, and efficient; and to be relevant to the assessment of different research projects.

This study reports on the costs incurred by diabetic patients participating in a screening programme to identify those individuals who may develop blindness. The investigation was based on the Welsh Community Diabetic Retinopathy Study (WCDRS) which has as its aim to assess the relative abilities of general practitioners (GPs) and community optometrists to detect diabetic retinopathy and especially sight-threatening diabetic retinopathy using direct ophthalmoscopy andmultiple field 35mm fundalphotography. Fourpractices, two urban and two rural, with a known prevalence of diabetes of at least 1.8% within their practice population have been participating in the WCDRS.All patients involved in the WCDRS (n=658) were sent questionnaires to complete. After one reminder letter a response rate of 89% was achieved. Questions related to the travel arrangements to and from the clinics for the eye examinations, including whether other people were involved, what people would have been doing if not attending the clinic, and the experiences of people attending the clinic.The majority of people travelled to the clinic by car and 80% arrived within 15 minutes. While large numbers of respondents did not specify whether any costs had been incurred, the average cost for those who did ranged from f0.55 in one urban practice to f 1.75 in one of the rural practices. Only 18% of those who responded would have been working if not attending the clinic. The vast majorify would have been engaged in other activities such as housework, visiting, socialising, leisure etc. The vast majority of those who accompanied the atfendees would also have been engaged in 'non-work' activities. The average time spent at the clinics was between 30 and 45 mintues.Translating these figures into costs incurred by patients and the companions accompanying them resulted in an average cost of f5.61 per patient and an additional f3.80 per companion. No attempt was made to assess the impact of the screening process on quality of life, although the patients reported no major problems in terms of anxiefy, pain and effects of the eye drops, with only some inconveniences mentioned. What was more significant was that 96% stated that they would be prepared to return to the clinic an undergo the same procedures if necessary. Diabetes Int 1997; 14(5): 1 28-1 31 P racfical

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