How to evaluate drugs: cost-effectiveness analysis

Article Abstract:

When presenting a new drug, pharmaceutical manufacturers consider whether it will be more effective than competing agents; if it is less costly; and whether it causes fewer side effects. Because new drugs are invariably more expensive than old ones, and because efficacy can be difficult to establish, reduction of side effects can become an important selling point. Cost-effectiveness analysis is one way of determining whether a reduction in side effects might give a drug a competitive edge over another equally effective and cheaper drug. This approach compares the health effects of a treatment (drug) with the cost of usage. The five steps in performing a cost-effectiveness analysis consist of construction of a decision tree, which describes the progression of the disease to be treated; establishing the probabilities of chance events in the model, usually derived from the medical literature; determining the outcome for health and expenses, using consistent methods of evaluation; assignment of probabilities and assessment of outcomes; and, finally, making the decision. Outcomes are weighted by their probabilities of occurrence, and their utilities are found by multiplying outcome values by probabilities. Since several outcome measures are generated, the cost of each is calculated separately. Costs, too, can be re-evaluated against the improvements the approach offers. Cost-effectiveness was used in an article in the July 4, 1990 issue of The Journal of the American Medical Association, which evaluated the use of misoprostol (a prostaglandin-like drug) for treating nonsteroidal anti-inflammatory drug-induced gastrointestinal tract bleeding (NSAID-induced), a problem that afflicts many people who take such drugs. One strength of the method is its ability to evaluate treatments before implementation (such as prescribing misoprostol for all patients taking NSAIDs, a very costly idea). Researchers and pharmaceutical manufacturers are advised to consider this approach when they are presented with new drugs to evaluate. (Consumer Summary produced by Reliance Medical Information, Inc.)

Economic aspects, Testing, editorial

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The safety effects of child-resistant packaging for oral prescription drugs: two decades of experience

Article Abstract:

Child-proof caps on prescription drugs have substantially reduced the death rate from accidental poisoning in young children. Researchers analyzed the cause of death among all children younger than 5 who died between 1964 and 1992. The death rate from accidental ingestion of prescription drugs among young children dropped substantially during that time, from 3.5 deaths per million children in the late 1960s to less than 2 deaths per million in the early 1990s. Death rates from accidental ingestion of drugs were twice as high before 1974, when child-proof caps were introduced, as after. However, death rates from unintentional injury in young children also dropped about 70% during this time. This indicates that other factors may be involved in the decline in death rates in young children. And many poisonings still take place because the child-proof cap is not used correctly or the drugs were dispensed in a bottle without a child-proof cap.

Patient outcomes, Mortality, Preschool children, Overdose, Child-resistant packaging, Child resistant packaging

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Access to Essential Drugs in Poor Countries A Lost Battle?

Article Abstract:

It seems unlikely that many patients in developing countries will have access to effective drugs. Pharmaceutical companies no longer develop many drugs for tropical diseases because there is no profit in it. Many drugs protected by patent are too expensive for patients in developing countries. These countries are also plagued by counterfeit drugs and drugs of poor quality. It is not clear what effect the 1997 World Trade Organization agreement will have on drug availability. The World Health Organization should take the lead in assuring access to drugs in developing countries.

International aspects, Developing countries

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