title: National Wilms' Tumor Study: economic perspective.
abstract: The National Wilms' Tumor Study poses a question of an essentially economic nature: Can the socioeconomic impact of therapy for Wilms' tumor on the patient's family and society be lessened without compromising the efficacy of therapy? But the only proposed measure of socioeconomic impact appears to be the extent of hospitalization. From an economic perspective, more information is ideally needed from the trial to establish the magnitude of any difference in effectiveness and the magnitude of the difference in costs, so that any trade-off between the two can be assessed. In practice, the extent of the economic data needed at the end of the study will depend on the clinical outcome results and, hence, the nature of the trade-off that will have to be made. If the less extensive treatment is found to be ineffective, economic issues will not come into play. Similarly, if the less extensive treatment is clearly superior in every clinical aspect, the argument for it will probably be persuasive. The interesting situation of a trade-off arises if the less extensive treatment offers clear socioeconomic advantages but has some small clinical disadvantage. In that case, the extent and nature of an array of socioeconomic factors will need to have been measured, not just presumed. There are, of course, many problems associated with collecting and analyzing more comprehensive socioeconomic data in a long trial. This article considers a number of these problems and focuses on six important issues in designing the necessary economic components of future trials.
authors.affiliation: Health Economics Research Group, Brunel University, Uxbridge, Middx, U.K.
authors.forename: M J
authors.initials: MJ
authors.lastname: Buxton
mesh_terms: D002648:Child; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic / Q000191:economics*; D009396:Wilms Tumor / Q000188:drug therapy*