Free-riding and the prisoner's dilemma : problems in funding economic analyses of phase III cancer clinical trials.
Both economic and clinical data on new agents are important to policy-makers who approve pharmaceuticals for widespread use.
Randomized clinical trials have been used to evaluate both clinical results and total medical costs associated with new agents.
With new expensive pharmaceutical agents, early assessments of economic benefit have taken on greater importance to physicians and patients.
Who should provide financial support to these integrated economic and clinical analyses in clinical trials ?
Here we describe issues that hinder funding of economic analyses and propose potential support mechanisms.
The Cancer and Leukemia Group B (CALGB), a large, national cooperative group of academic and community hospitals in the United States, designed a non-small-cell lung cancer (NSCLC) treatment trial to compare two widely used supportive care regimens that varied 20-fold in cost.
One important objective of this trial was to compare the cost-effectiveness of the two regimens.
Economic theory predicts difficulties in evaluating cost-effectiveness of new pharmaceuticals and reluctance to support economic analyses of clinical trials.
Economic analyses will require new sources of funds that will not take scarce resources from clinical trials groups.
Options for funding include a new federal agency, coordinated work by existing agencies, or academic centers for economic analysis.
Mots-clés Pascal : Tumeur maligne, Homme, Anticancéreux, Médicament, Essai clinique phase III, Analyse coût efficacité, Analyse économique, Théorie économique, Financement, Etats Unis, Amérique du Nord, Amérique, Economie santé
Mots-clés Pascal anglais : Malignant tumor, Human, Antineoplastic agent, Drug, Phase III trial, Cost efficiency analysis, Economic analysis, Economic theory, Financing, United States, North America, America, Health economy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0507379
Code Inist : 002B30A11. Création : 01/03/1996.