title: Cost-efficiency of knowledge creation: randomized controlled trials vs. observational studies.
abstract: OBJECTIVE
  This article reviews traditional and current perspectives on randomized, controlled trials (RCTs) and observational studies relative to the economic implications for public healthcare stakeholders.
  
  
  RESULTS
  It takes an average of 17 years to bring 14% of original research into clinical practice. Results from high-quality observational studies may complement limited RCTs in primary and secondary literature bases, and enhance the incorporation of sound evidence-based guidelines. Observational findings from comprehensive medical databases may offer valuable clues on the effectiveness and relevance of public healthcare interventions. Major expenditures associated with RCTs relate to recruitment, inappropriate site selection, conduct and reporting. Application of business strategies and economic evaluation tools, in addition to the planning and conduct of RCTs, may enhance clinical trial site performances.
  
  
  CONCLUSIONS
  Considering the strengths and limitations of each study type, clinical researchers should explore the contextual worthiness of either design in promulgating knowledge. They should focus on quality of conduct and reporting that may allow for the liberation of limited public and private clinical research funding.
authors: Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany.
authors: Rafael
authors: R
authors: Struck
authors: Georg
authors: G
authors: Baumgarten
authors: Maria
authors: M
authors: Wittmann
mesh_terms: D003362:Cost-Benefit Analysis; D006801:Humans; D019359:Knowledge; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic / Q000191:economics*