2. Give more weight to real health outcomes than changes in risk factors.
3. Look at the full range of alternatives rather than those selected by industry when considering claims for advantages of new treatments.
4. Understand that variation in effects across individuals or subgroups argues against restrictions on first-line treatment, but only if those differences are predictable.
5. Understand that variation in effects argues against requiring changes in ongoing treatment.
"The money we have available for health care is not unlimited," said Simon. "Health insurers and government agencies that pay for health care have a responsibility to make sure the money we have is used for the greatest benefit. Our society tends to assume that a newer, more expensive treatment must be more effective. That assumption can be bad for our pocketbooks and our health."
Principles for evidence-based drug formulary policy
1. Give more weight to true experiments than to models or simulations, and carefully examine assumptions of such models.
The highest standard for finding true differences between newer and older treatments is the "randomized controlled trial," where study participants are assigned to different treatments by chance. Those "gold standard" comparisons are costly and may take years to complete. Policy makers sometimes rely on simulated comparisons, but those comparisons are often based on expert opinion and subject to bias. "When models or simulations are the best data available, appropriate skepticism is necessary," the authors write.
As an example, they point to Cox-2 inhibitor drugs such as Vioxx and Celebrex, which are more expensive, but no more effective on average, than older anti-inflammatory drugs. Simulated comparisons supported by the pharmaceutical industry showed that Cox-2 inhibitors could save money in the long run by reducing the risk of ulcers and intestinal ble
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Contact: Joan DeClaire
declaire.j@ghc.org
206-287-2653
Group Health Cooperative Center for Health Studies
28-Oct-2005