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Building castles on sands or quicksands?

The strengths and weaknesses of economic evaluation in pharmaceuticals

Published online by Cambridge University Press:  06 August 2018

Alan Maynard
Affiliation:
York Health Economics Consortium, University of York
Karen Bloor
Affiliation:
Department of Health Sciences and Clinical Evaluation, University of York
Corresponding
E-mail address:

Extract

Economic evaluations of new and existing pharmaceutical products are an essential input into decision-making in health care. Health care systems around the world face steady increases in the total cost of pharmaceuticals. Increasingly, health care funders have to choose which drugs are subsidised and which are not reimbursed from public funds. In psychiatry, a number of new pharmaceutical products have recently been developed for the treatment of depression and schizophrenia which cost considerably more than traditional pharmacological products. Governments and purchasers, with limited budgets and expanded demands for funding, require pharmaceutical companies to demonstrate the cost-effectiveness of their new therapies. It is no longer sufficient to consider the clinical or therapeutic effects of new drugs: purchasing choices are predicted on studies which identify, measure and value what is given up when a product is used (the cost) and what is gained (improved health outcome).

Type
Research Article
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

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References

Addington, D. E., Jones, B., Bloom, D., et al (1993) Reduction of hospital days in chronic schizophrenic patients treated with risperidone: a retrospective study. Clinical Therapeutics, 15, 917926.Google ScholarPubMed
Altman, D. (1994) The scandal of poor medical research. British Medical Journal, 308, 283284.CrossRefGoogle ScholarPubMed
Adams, M., McCall, N., Gray, D., et al (1992) Economic analysis in randomized controlled trials. Medical Care, 30, 231243.CrossRefGoogle Scholar
Aristides, M. & Mitchell, A. (1994) Applying the Australian guidelines for the reimbursement of pharmaceuticals. Pharmacoeconomics, 6, 196201.CrossRefGoogle ScholarPubMed
Baldessarini, R. (1985) Chemotherapy in Psychiatry: Principles and Practice. Boston, MA: Harvard University Press.Google Scholar
Bailar, J. (1976) Bailar's laws of data analysis. Clinical Pharmacological Therapy, 20, 113120.CrossRefGoogle ScholarPubMed
Canadian Coordinating Office for Health Technology Assessment (1994) Guidelines for Economic Evaluation of Pharmaceuticals in Canada. Toronto: CCOHTA.Google Scholar
Cairns, I. (1992) Discounting and health benefits: another perspective. Health Economics, 1, 7679.CrossRefGoogle ScholarPubMed
Cairns, I. (1994) Valuing future benefits. Health Economics, 3, 221229.CrossRefGoogle ScholarPubMed
Commonwealth Department of Health, Housing and Community Services (1992) Guidelines for the Pharmaceutical Industry on Preparation of Submissions to the Pharmaceutical Benefits Advisory Committee. Canberra: CDHHCS.Google Scholar
Davies, L. & Drummond, M. (1993) Assessment of the costs and benefits of drug therapy for treatment-resistant schizophrenia in the United Kingdom. British Journal of Psychiatry, 162, 3842.CrossRefGoogle ScholarPubMed
Davis, J. M., Schaffer, C. B., Killian, G. A., et al (1980) Important issues in drug treatment of schizophrenia. Schizophrenia Bulletin, 6, 7087.CrossRefGoogle ScholarPubMed
Department of Health (1994) Guidelines for the Economic Evaluation of Pharmaceuticals. Press release 94/251. London: Department of Health.Google Scholar
Department of Health and Social Security (1986) Mental Health Statistics. London: HMSO.Google Scholar
Der, G., Gupter, S. & Murray, R. (1990) Is schizophrenia disappearing? Lancet, 335, 513515.CrossRefGoogle Scholar
Detsky, A. (1993) Guidelines for economic analysis of pharmaceutical products – a draft document for Ontario and Canada. Pharmacoeconomics, 3, 354361.CrossRefGoogle ScholarPubMed
Drug and Therapeutics Bulletin (1993) Risperidone and remoxipride for schizophrenia. Drug and Therapeutics Bulletin, 31, 101102.Google Scholar
Drummond, M. (1992) Cost-effectiveness guidelines for reimbursement of pharmaceuticals: is economic evaluation ready for its enhanced status? Health Economics, 1, 8592.CrossRefGoogle ScholarPubMed
Drummond, M. & Davies, L. (1991) Economic analysis alongside clinical trials: revisiting the methodological issues. International Journal of Technology Assessment in Health Care, 7, 561573.CrossRefGoogle ScholarPubMed
Drummond, M., Stoddart, G. & Torrance, G. (1988) Methods for the Economic Evaluation of Health Care Programmes. Oxford: Oxford University Press.Google Scholar
Eagles, I. & Whalley, L. (1985) Decline in the diagnosis of schizophrenia among first admissions to Scottish mental hospitals from 1969–78. British Journal of Psychiatry, 146, 151154.CrossRefGoogle Scholar
Edwards, J. (1994) Risperidone for schizophrenia: encouraging results awaiting further research. British Medical Journal, 308, 13111312.CrossRefGoogle Scholar
Freemantle, N. & Maynard, A. (1994) Something rotten in the state of clinical and economic evaluations. Health Economics, 3, 6367.CrossRefGoogle ScholarPubMed
Freemantle, N., Sheldon, T., Song, F., et al (1994) Letter. British Medical Journal, 309, 1085.Google Scholar
Fryers, T. & Wooff, K. (1989) A decade of mental health care in an urban community: patterns and trends in Salford 1976–86. In Health Service Planning and Research (ed. Wing, J. K.), pp. 3152. London: Gaskell.Google Scholar
G⊘tzche, P. (1989) Methodology and overt and hidden bias in reports of 196 double-blind trials of nonsteroidal anti-inflammatory drugs in rheumatoid arthritis. Controlled Clinical Trials, 10, 3156.Google Scholar
Heinrich, K., Kleiser, E., Lehmann, E., et al (1994) Risperidone versus clozapine in the treatment of schizophrenic patients with acute symptoms: a double-blind, randomised trial. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 18, 129137.CrossRefGoogle Scholar
Hillman, A., Eisenberg, J., Pauly, M., et al (1991) Avoiding bias in the conduct and reporting of cost-effectiveness research sponsored by pharmaceutical companies. New England Journal of Medicine, 324, 867872.CrossRefGoogle ScholarPubMed
Hirsch, S. & Puri, B. (1993) Clozapine: progress in treating refractory schizophrenia. British Medical Journal, 306, 643657.CrossRefGoogle ScholarPubMed
Kane, J., Honigfield, G., Singer, J., et al (1988) Clozapine for the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine. Archives of General Psychiatry, 45, 789796.CrossRefGoogle ScholarPubMed
Kassirer, I. & Angell, M. (1994) The journal's policy on cost-effectiveness analyses. New England Journal of Medicine, 330, 669670.CrossRefGoogle Scholar
Klein, R. (1993) Health care reform: the global search for Utopia. British Medical Journal, 307, 752.CrossRefGoogle ScholarPubMed
Koopmanschap, M. A. & van Ineveld, B. M. (1992) Towards a new approach to estimating indirect costs of disease. Social Science and Medicine, 34, 10051010.CrossRefGoogle ScholarPubMed
Livingston, M. (1994) Risperidone. Lancet, 343, 457460.CrossRefGoogle ScholarPubMed
Marder, S. & van Putten, T. (1988) Who should receive clozapine? Archives of General Psychiatry, 48, 865867.CrossRefGoogle Scholar
Mehrez, A. & Gafni, A. (1992) Preference based outcome measures for economic evaluation of drug interventions: quality adjusted life years (QALYs) versus equivalents (HYEs). Pharmacoeconomics, 1, 338345.CrossRefGoogle Scholar
Meltzer, H., Cola, P., Way, L., et al (1993) Cost effectiveness of clozapine in neuroleptic resistant schizophrenia. American Journal of Psychiatry, 150, 16301640.Google ScholarPubMed
Munk-Jorgenson, P. (1987) Why has the incidence of schizophrenia in Danish psychiatric institutions decreased since 1970? Acta Psychiatrica Scandinavica, 175, 6268.CrossRefGoogle Scholar
Ontario Ministry of Health (1994) Ontario guidelines for economic analysis of pharmaceutical products. Ontario: Ministry of Health.Google Scholar
Olsen, J. (1993) Time preference for health gains: an empirical investigation. Health Economics, 22, 257266.CrossRefGoogle Scholar
Overall, J. E. & Gorham, D. R. (1962) The Brief Psychiatric Rating Scale. Psychological Reports, 10, 799812.CrossRefGoogle Scholar
Oxman, A. (1994) Checklists for review articles. British Medical Journal, 309, 648651.CrossRefGoogle ScholarPubMed
Parsonage, M. & Neuburger, H. (1992) Discounting and health benefits. Health Economics, 1, 7176.CrossRefGoogle ScholarPubMed
Rennie, D. & Flanagin, A. (1994) The second international congress on peer review in biomedical publication. Journal of the American Medical Association, 272, 9192.CrossRefGoogle ScholarPubMed
Revicki, D., Luce, B., Weschler, J., et al (1990) Cost effectiveness of clozapine for treatment resistant schizophrenia patients. Hospital and Community Psychiatry, 41, 850854.Google Scholar
Robins, L. & Regier, D. (1991) Psychiatric Disorders in America: the Epidemiological Catchment Areas Study. New York: Free Press.Google Scholar
Rochon, P., Gurwitz, J., Simms, R., et al (1994) A study of manufacturer supported trials of nonsteroidal anti-inflammatory drugs in the treatment of arthritis. Archives of Internal Medicine, 154, 157163.CrossRefGoogle ScholarPubMed
Sartorius, N., Jablensky, A., Korter, A., et al (1987) Early manifestations and first contact incidence of schizophrenia in different cultures. Psychological Medicine, 16, 908928.Google Scholar
Song, F. (1997) Risperidone in the treatment of schizophrenia: a meta-analysis of randomised controlled trials. Journal of Psychopharmacology, 11, 6571.CrossRefGoogle Scholar
Soumerai, S. & Avorn, J. (1990) Principles of education outreach (academic detailing) to improve clinical decision-making. Journal of the American Medical Association, 253, 549556.CrossRefGoogle Scholar
Udvarhelyi, I., Colditz, G., Rai, A., et al (1992) Cost-effectiveness and cost benefit analyses in the medical literature. Annals of Internal Medicine, 116, 238244.CrossRefGoogle ScholarPubMed
Williams, A. (1974) The cost benefit approach. British Medical Bulletin, 30, 252256.CrossRefGoogle ScholarPubMed
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