LETTER
Principles of Economic Analysis of Health Care Technology
Jose Antonio Sacristan, MD;
Javier Soto, MD; and
Jesus M. Hernandez, MD
1 March 1996 | Volume 124 Issue 5 | Pages 535-536
TO THE EDITOR:
In a recent editorial on economic analysis of health care technologies, Evans [1] states, "Since the new sponsors of research [pharmaceutical companies] have such an obvious commercial interest in the outcomes, why should we believe them?"
Pharmaceutical companies are interested in developing drugs with clinical and economic advantages. This could lead to a potential bias in the conduct and reporting of company-sponsored cost-effectiveness analyses [2]. Dr. Evans seems to forget, however, that other potential sources of bias may exist, such as the interest of a payer to reduce its total health expenditure budget. Would it not be attractive for a so-called "neutral source," such as a government agency, to show that the cheapest drug is also the most cost-effective? This would be particularly true when these institutions fund health care, as they do in many European countries. Following Evans' rule, why should we believe the results of a theoretical study that is funded by a government agency and shows that a new (and expensive) drug is not cost-effective?
Guidelines do not guarantee the quality of a study, but they may introduce some consistency to the methods, which is essential for conducting scientific research. Health economics evaluations should have one main objective: to increase our knowledge of the efficiency of drugs and other health technologies so that their use in society is improved. In Evans' editorial, one can find some of the conventional prejudgments against research sponsored by pharmaceutical companies. These companies are not the only sponsors of economic assessment; most (74%) of the cost-effectiveness studies published in six scientific medical journals (American Journal of Medicine, Annals of Internal Medicine, British Medical Journal, Journal of the American Medical Association, The Lancet, and The New England Journal of Medicine) from 1988 to 1993 were financed by public institutions and private foundations [3].
Standardized methods should be a common objective of researchers and sponsors. Dr. Evans' should not ask why pharmaceutical companies supported the Task Force on Principles for Economic Analysis of Health Care Technology [4] but rather why other potential sponsors did not.
Jose Antonio Sacristan, MD
Javier Soto, MD
Jesus M. Hernandez, MD
Lilly SA
Madrid, Spain
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Author and Article Information
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Madrid, Spain
1. Evans RG. Manufacturing consensus, marketing truth: guidelines for economic evaluation [Editorial]. Ann Intern Med. 1995; 123:59-60.
2. Hillman AI, Eisenberg JM, Pauly MV, Bloom BS, Glick H, Kinosian B, et al. Avoiding bias in the conduct and reporting of cost-effectiveness research sponsored by pharmaceutical companies. N Engl J Med. 1991; 324:1362-5.
3. Sacristan JA, Navarro O, Casado MA, Reviriego J, Soto J. Publication bias in pharmacoeconomic studies? Eighth International Conference on Pharmaceutical Medicine. Rome; 27-29 April 1994.
4. Task Force on Principles for Economic Analysis of Health Care Technology. Economic analysis of health care technology. A report on principles. Ann Intern Med. 1995; 122:61-70.
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