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May 9, 1990

Comparing Benefits and Harms: The Balance Sheet

Author Affiliations

Duke University Durham, NC

Duke University Durham, NC

JAMA. 1990;263(18):2493-2505. doi:10.1001/jama.1990.03440180103043

THE CENTRAL elements of a decision about a medical activity, and therefore the central elements of a policy statement, are the consequences of the interventions that are being considered—their benefits, harms, and costs. The estimates of health and economic outcomes condense the information from clinical research and clinical experience into a form suitable for decisions and provide the basis for judgments about the desirability of the intervention.

A simple but powerful way to present information on the outcomes of an intervention is the balance sheet. The idea is old and familiar; when you are trying to decide between two or more options that are complex and important, such as whether to buy a new car, make a list of the pros and cons of each option. The overall goal of the balance sheet is to help decision makers develop an accurate understanding of the important consequences of the different options.