Cost-effectiveness comparisons using "real world" randomized trials: the case of new antidepressant drugs.
While randomized clinical trials remain the "gold standard" for comparisons of treatment efficacy, conventional randomized trials may not reflect the relative effectiveness of treatments under "real world" conditions. Observational data more closely reflect the conditions of actual practice, but are often limited in clinical detail and subject to bias in selection of treatments. The authors use available data on the cost-effectiveness of new antidepressant drugs to illustrate the limitations of these methods. Modifications to the traditional randomized trial may allow more accurate assessment of effectiveness in everyday practice. The authors describe the design of such a "real world" randomized trial comparing newer antidepressants with older alternatives.
Simon
G
G
Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, WA 98101.
Wagner
E
E
Vonkorff
M
M
D000928:Antidepressive Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003891:Desipramine / Q000627:therapeutic use; D016527:Drug Costs; D005473:Fluoxetine / Q000627:therapeutic use; D006801:Humans; D007099:Imipramine / Q000627:therapeutic use; D010349:Patient Compliance; D016032:Randomized Controlled Trials as Topic / Q000592:standards*; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics / Q000627:therapeutic use; D014481:United States
D000928:Antidepressive Agents; D003891:Desipramine; D005473:Fluoxetine; D007099:Imipramine; D017367:Selective Serotonin Reuptake Inhibitors