Economic analyses of clinical trials in cancer: are they helpful to policy makers?
Although clinical trials are being used to evaluate economic outcomes of new agents, there are methodological problems. Decisions based on these analyses may lead to inefficient use of medical resources. Randomized clinical trials provide important information on the efficacy of new pharmaceutical agents for cancer patients. Policy makers are likely to require both economic and clinical data in order to approve pharmaceuticals for widespread use. Clinical trials provide an opportunity to evaluate economic outcomes for new agents. However, the interpretation of economic analyses of clinical trials raises issues related to perspective of the investigators, study design, collection of data on resource utilization, and generalizability of data to other settings. In this paper, we review these issues and illustrate problems associated with analyses of economic data from a recent phase III trial of hematopoietic growth factors. Clinical results were similar in both Paris and New York in this phase III trial. However, economic results differed markedly between the hospital in Paris and the hospital in New York. While significant savings in terms of fewer days in the hospital and fewer laboratory tests and radiographs for the granulocyte-macrophage colony-stimulating factor (GM-CSF) patients were noted at the New York hospital, resource savings were not identified at the hospital in France. Caution must be used when reimbursement policies are based on economic analyses of clinical trials. Policy decisions must be based on studies that are carefully conducted, analyzed, and interpreted from both a clinical and an economic perspective.
Division of Health Services Research and Development, Durham Veterans Affairs Hospital, North Carolina.
C L
CL
Bennett
J L
JL
Armitage
S
S
LeSage
S C
SC
Gulati
J O
JO
Armitage
N C
NC
Gorin
D000900:Anti-Bacterial Agents / Q000191:economics; D001803:Blood Transfusion / Q000191:economics; D016026:Bone Marrow Transplantation / Q000191:economics; D002986:Clinical Trials as Topic / Q000191:economics*; D003131:Combined Modality Therapy / Q000191:economics; D004311:Double-Blind Method; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000191:economics / Q000627:therapeutic use*; D006291:Health Policy / Q000191:economics; D016298:Hematopoietic Cell Growth Factors / Q000191:economics / Q000627:therapeutic use; D006760:Hospitalization / Q000191:economics; D006801:Humans; D009369:Neoplasms / Q000191:economics* / Q000628:therapy; D009518:New York; D010297:Paris; D016032:Randomized Controlled Trials as Topic / Q000191:economics; D011993:Recombinant Fusion Proteins / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D016298:Hematopoietic Cell Growth Factors; D011993:Recombinant Fusion Proteins; D016178:Granulocyte-Macrophage Colony-Stimulating Factor