Institute of Clinical Economics e.V.

Institute of Clinical Economics e. V.

The footprint of the ICE e.V.

For our friends and interested parties:

In the following lines the contribution of the ICE e.V. to the solution of health problems is
compiled in three points, which was worked out in the last 20 years.

  1. the safety loop describes the connection between objective risk, the communication, thesubjective perception of the objective risk (term: "perceived safety"), the decision making and the effect of the decision on the change of the objective initial risk [1 - 3].
  2. the terminology conflict describes the misunderstanding between "efficacy" and "effectiveness"in health care and the resulting consequences [4 - 7].
  3. the method for proving "real word effectiveness" and its integration into a three-dimensional strategy for proving "proof of principle", "real world effectiveness" and "value", describe the probably inevitable paradigm shift that has to be made to make health care financially viable. [8 - 14]

The relationship between objective risks, risk communication, the resulting "Perceived Safety", our decisions and their effects on the objective risks predicts the central importance of risk communication. In my opinion, risk communication plays a central role in health care / health care management, which is associated with a considerable influence on the economic efficiency of health care. Without professional communication, which is based on the connection between objective risks and the subjective (emotional) decision strategies, a cost-covering health care - because of the necessary coverage of the already made expenses - will hardly be achieved.

The terminology conflict and its solution describes the scientific basis for the distinction between theoretical laboratory findings and practical everyday effects, the validity of which we were presented with in the "diesel scandal" between the results in the laboratory and on the road. The same problem has been known to medicine for 80 years. That is why Sir Archibald Cochrane and Sir Austin Bradford Hill demanded answers to the three questions: "Can it work?", "Does it Work?", "Is it worth it?".

Our group has translated the answers to these three questions into a strategy and has also developed the method that can be used to provide evidence of everyday suitability (Does it work?).

To develop the method that enables the proof of Real-World Effectiveness, we had to follow the rule of Albert Einstein (*1879 in Ulm): "A problem cannot be solved by the method that caused the problem". We  combined this recommendation with the tenet of American designersand architects "Form Follows Function (FFF)" and applied it to answer the Cochrane-Hill questions.

This led to the realization that proof of suitability for everyday use (Real-World Effectiveness) can only be provided if the supply takes place under the non-structured conditions of "Natural Chaos", but at the same time structured conditions can be applied for the undistorted measurement of the effects achieved. This apparent "squaring of the circle" can be solved by replacing randomization by Bayes' principle.

Franz Porzsolt

1. F. Porzsolt: Safety means perception of risk. In: J Med Safety, 2016, Oct, S. 18–24. ISSN 1349-5232
2. F. Porzsolt: Clinical Economics – It is about Values not about Money. In: Brazil J Medicine Human Health, 2016,4 (3). doi:10.17267/2317-3386bjmhh.v4i3.1052
3. Porzsolt F, Pfuhl G, Kaplan RM, Eisemann M. Covid-19 pandemic lessons: Un-critical communication of test results can induce more harm than benefit and raises questions on standardized quality criteria for communication and lia-bility. Health Psychology and Behavioral Medicine 2021;9:818-829. DOI 10.1080/21642850.2021.1979407
4. F. Porzsolt, F. Wiedemann, K. Schmaling, RM. Kaplan: The risk of imprecise ter-minology: incongruent results of clinical recommendations in clinical trials and in-congruent recommendations in clinical guidelines. (Suppl 1) A17-A18; doi:10.1136/bmjebm 2019;24.
5. K. Schmaling, RM. Kaplan, F. Porzsolt: Efficacy and effectiveness studies of de-pression are not well-differentiated in the literature: a systematic review. In: BMJ Evid Based Med., 2020 Mar 18. doi:10.1136/bmjebm-2020-111337.
6. F. Porzsolt, F. Wiedemann, M. Phlippen, C. Weiss, M. Weiss, K. Schmaling, RM. Kaplan: The terminology conflict on efficacy and effectiveness in healthcare. In: J Comp Eff Res., 2020 Dec, 9(17), S. 1171–1178. doi:10.2217/cer-2020-0149. Epub 2020 Dec 14. PMID 33314965.
7. F. Wiedemann, F. Porzsolt: The Terminology Conflict on Efficacy and Effective-ness in Clinical Trials on Health-Related Quality of Life. Research Square. 2021. doi:10.21203/
8. F. Porzsolt, E. Pöppel: Kommentar: Zur Diskussion über das drohende Ende der randomisierten kontrollierten Studien – es geht ans Eingemachte. In: DMW, 2000, 125(45), S. A14.
9. F. Porzsolt, NG. Rocha, Toledo-Arruda AC, TG. Thomaz, C. Moraes, Bessa-Guerra TR, Leão M, A. Migowski, AR. Araujo de Silva, C. Weiss: Efficacy and Effectiveness Trials Have Different Goals, Use Different Tools, and Generate Differ-ent Messages. In: Pragmatic and Observational Research, 2015,6, S. 47–54. doi:10.2147/POR.S89946
10. F. Porzsolt, Weiss Ch, M. Weiss, AG. Müller, SI. Becker, M. Eisemann, RM. Kaplan: Versorgungsforschung braucht dreidímensionale Standards zur Beschreibung von Gesundheitsleistungen [Health services research needs three-dimen-sional standards for description of health services]. In: Monitor Versorgungsforschung, 2019, 04, S. 53–60. doi:10.24945/MVF.04.19.1866-0533.2163
11. F. Porzsolt, F. Wiedemann, M. Phlippen, C. Weiss, M. Weiss, K. Schmaling, RM. Kaplan: The terminology conflict on efficacy and effectiveness in healthcare. In: J Comp Eff Res., 2020 Dec, 9(17), S. 1171–1178. doi:10.2217/cer-2020-0149. Epub 2020 Dec 14. PMID 33314965.
12. F. Porzsolt, C.A. Gonçalves, P.C.M. Mayer. Interprofessional approach for Development of Evidencebased Medicine: Merging the Designer Rule Form Follows Function with the Epidemiological Questions: Can it work? Does it work? Is it worth it? Submitted for publication, 2022.
13. F. Porzsolt, M. Weiss, F. Lautenschlager, P. Legrum, C. Weiss. Combination of the Minimum Clinically Important Difference (MCID) with the Minimum Detectable Change (MDC): Implementation of the unfulfilled requirement of clinical epidemi-ology “Subjective assumptions are to be confirmed by objective statements”. Submitted for publication 2022.
14. F. Porzsolt, Ch. Weiss, B. Herzberger, M. Weiss. Optimization of the ‘Joint Option: The randomized controlled trials (RCTs) describe proof of principle as op-posed to pragmatic controlled trials (PCTs) which describe real-world effectiveness. Submitted for publication 2023.

Our Vision

We want to support the development of a health care system that uses existing resources as equitably and effectively as possible for our society in order to achieve the greatest possible benefit. We rely primarily on scientific evidence from care research and clinical economics to identify the value of health care services under real world conditions from the point of view of patients and the community of solidarity.

Our Mission

  • Promotion of science and research, in particular with methods and concepts of clinical economics. The aim is to support professional societies and self-governing bodies in the creation of evidence and to support the critical discussion regarding the efficient use of resources (such as the application of common health services, their remuneration and effectiveness).
  • Dissemination of the concepts and application of evidence-based medicine and clinical economics in education and training for health professions.
  • Use of the interdisciplinary competences of the association for effective solution development and its dissemination in the context of publications and events.

Our Contribution

We want to support the development and use of new scientific findings. To this end, we actively participate in the scientific debate through publications on the topic.


Clinical Economics

deals with the creation of health-related value for individuals and society without prioritizing monetary benefits.

The misjudgement in our health care systems is based on the assumption that more screening, more diagnostics and more therapy will always lead to better health. However, this assertion is not supported by modern literature.


There is a risk of oversupply in the health care systems of all industrialised countries. Oversupply exists in two forms: the "ineffective therapy", if the problems of the patients are not solved by the administered therapy and the "spontaneous healing", if the problems of the patients are solved without therapy.

Efficient supply

Efficient therapy (psychological, biochemical, etc.) improves the health of patients, with the sum of benefits outweighing the negative effects and costs. Unfortunately, it is difficult to find valid and efficient care because investigations and reports contain systematic errors due to existing conflicts of interest.

Further information can also be found in our statutes (German language).