Health policy decisions between rationing and rationalisation as demonstrated by the example of erythropoietin in tumour anaemia

The debate on rationalisation vs, rationing of health care interventions is of great importance for the shaping of social and health care policies. Ne vertheless, concrete evaluations mostly deal with health interventions in t he grey zone between rationing - withholding effective measures - and ratio nalisation - avoiding ineffective interventions. The assessment of erythrop oietin in tumour anaemia is presented as an example: the results of the tre atment of tumour-induced anaemia with EPO are partly unsatisfactory. Only 5 0-60 % of anemic tumor-patients repond to EPO; of these responders 20-30% s till require transfusions. The assessment presents the evidence for an "app ropriate" application of erythropoietin in tumour anaemia and proposes stan dard values for a limited access and use of EPO, Additionally the assessmen t reveals what is known as the benefit of this treatment, and what is quest ionable. Applying the results of the assessment to clinical pratice can be considered as "explicit rationing" according to effectiveness criteria.