Manufacturing Consensus, Marketing Truth: Guidelines for Economic Evaluation

Economic analysis is increasingly applied to medical practices. Interest in both the methods and the results of these analyses is growing on all sides. This issue of Annals contains a report from a task force, organized by faculty from the Leonard Davis Institute of the University of Pennsylvania, with financial support from industry sources, that examines the issue of standard setting for economic analyses of health care technologies. A contrasting view appears in the following editorial. Readers interested in an international perspective on the topic will want to read the recent editorial by Freemantle and colleagues (BMJ. 1995; 310:955-6).—The Editor

The economic appraisal of health care interventions has a long history. Twenty years ago, Culyer and colleagues [1] compiled a 70-page bibliography on the subject, and manuals of methods and principles have been available for more than a decade [2]. The evaluative techniques themselves are older still [3].

What is quite new, as noted by the Task Force on Principles for Economic Analysis of Health Care Technology in this issue [4], is the “widespread use of economic analysis … (in) support(ing) the pricing and marketing of new interventions.” A pseudo-discipline, “pharmacoeconomics,” has been conjured into existence by the magic of money, with its own practitioners, conferences, and journals. There are a lot of drugs, and there is a lot of money, so the “field” is booming [5].

But drug marketing is even older than economic evaluation. So why now? Why have the marketers so recently become so interested in these techniques?

Perhaps the interest has developed because the environment in which drugs are purchased is changing, at least in the United States [6]. Control over decisions on drug purchasing is allegedly shifting to the health care plan managers who must actually pay for the drugs. …