title: Making smart investment decisions in clinical research.
abstract: A recent trial in rheumatoid arthritis found an inexpensive, but infrequently used, combination of therapies is neither inferior nor less safe than an expensive biologic drug. If the trial had been conducted over 10 years ago, arguably 100's of millions of dollars since spent on biologics could have been released to other, more effective treatments. Given the ever increasing number of trials proposed, this commentary uses the trial as an example to challenge payers and research funders to make smarter investments in clinical research to save potential future costs.
  
  
  BACKGROUND
  NCT00405275 , registered 29 November 2006.
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. nick.bansback@ubc.ca.|Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada. nick.bansback@ubc.ca.|Arthritis Research Centre for Canada, Vancouver, Canada. nick.bansback@ubc.ca.
authors.forename: Nick
authors.initials: N
authors.lastname: Bansback
authors.affiliation: University of Toronto, Toronto, Canada. edkeystone@mtsinai.on.ca.|The Rebecca MacDonald Centre for Arthritis & Autoimmune Diseases, Mount Sinai Hospital, Toronto, Canada. edkeystone@mtsinai.on.ca.
authors.forename: Edward
authors.initials: E
authors.lastname: Keystone
authors.affiliation: Nebraska-Western Iowa Health Care System, Omaha, USA. jrodell@unmc.edu.|University of Nebraska Medical Center, Omaha, USA. jrodell@unmc.edu.
authors.forename: James
authors.initials: J
authors.lastname: O'Dell
authors.affiliation: Health Economics Resource Center and the Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA. cphibbs@stanford.edu.|Department of Health Research and Policy and the Center for Primary Care Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA. cphibbs@stanford.edu.
authors.forename: Ciaran S
authors.initials: CS
authors.lastname: Phibbs
authors.affiliation: VA Cooperative Studies Program Coordinating Center, Boston, USA. Keri.Hannagan@va.gov.
authors.forename: Keri
authors.initials: K
authors.lastname: Hannagan
authors.affiliation: VA Cooperative Studies Program Coordinating Center, Boston, USA. Mary.Brophy@va.gov.|School of Medicine, Boston University, Boston, USA. Mary.Brophy@va.gov.
authors.forename: Mary
authors.initials: M
authors.lastname: Brophy
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. aslam.anis@ubc.ca.|Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada. aslam.anis@ubc.ca.|Arthritis Research Centre for Canada, Vancouver, Canada. aslam.anis@ubc.ca.
authors.forename: Aslam
authors.initials: A
authors.lastname: Anis
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D001688:Biological Products / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004345:Drug Industry / Q000191:economics; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine / Q000191:economics; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000191:economics; D016032:Randomized Controlled Trials as Topic / Q000191:economics*; D012109:Research Support as Topic; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products