Conflict of Interest and Cost-effectiveness Analysis

Krimsky, Sheldon

doi:10.1001/jama.282.15.1474

Cited by 45 publications

(25 citation statements)

References 18 publications

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“…Despite these limitations, this systematic review indicates that conflict of interest was common in the economic analyses of aromatase inhibitors for treatment of breast cancer. This conflict of interest could account for varying assessments of cost-effectiveness among aromatase inhibitors found in a previous systematic review [14]. Thus, clinicians and policymakers should be aware of the potential influence of pharmaceutical company sponsorship on the outcomes of economic studies of the relative value of different medical interventions.…”

Section: Discussionmentioning

confidence: 99%

“…Pharmaceutical company sponsorship of economic analyses is associated with a reduced likelihood of reporting unfavorable conclusions about a sponsor's proprietary agent [13]. Several plausible explanations for this finding have been proposed including in-house prescreening, selective use of clinical efficacy data, devising protocols during analysis, qualitative overstatements of quantitative results, and publication bias [14]. To better understand the role of study sponsorship on cost-effectiveness analyses, we performed a systematic literature review to determine whether an association exists between pharmaceutical industry sponsorship and economic assessments of aromatase inhibitors.…”

Section: Introductionmentioning

confidence: 99%

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Conflict of interest in economic analyses of aromatase inhibitors in breast cancer: a systematic review

Jang

Chae

Haddad

et al. 2010

Breast Cancer Res Treat

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To determine whether authors conducting economic analyses of aromatase inhibitors in breast cancer are less likely to reach unfavorable conclusions if the economic study is sponsored by the manufacturer of the drug. Articles reporting the economic analyses of aromatase inhibitors in breast cancer were selected from PubMed in May 2009. Information was collected on the types of analysis, the qualitative conclusion, the quantitative results, and the funding sources. Fisher's exact test was conducted to compare the frequency of unfavorable conclusions based on study sponsorship. Thirty-two eligible articles were identified. Twenty-six were funded by pharmaceutical companies, and 4 were funded by non-pharmaceutical companies. Two studies did not report a funding source. Twenty-one studies evaluated aromatase inhibitors in the adjuvant setting, while 11 studies examined their use in advanced breast cancer. Twenty-two studies evaluated one type aromatase inhibitor, while 10 compared multiple types of aromatase inhibitors. Only one of the 26 (4%) pharmaceutical company-sponsored studies reported unfavorable cost-effectiveness of an aromatase inhibitor, which was a competitor's product, whereas two of four (50%) non-pharmaceutical company-sponsored studies concluded aromatase inhibitors are not cost-effective in certain clinical scenarios (P < 0.05). Seven pharmaceutical company-sponsored studies conducted a comparison among several aromatase inhibitors; all 7 studies reported favorable conclusions for the sponsoring company's products. The majority of economic analyses of aromatase inhibitors in breast cancer are sponsored by pharmaceuticals. Economic evaluations of aromatase inhibitors in breast cancer that are funded by a pharmaceutical company are less likely to reach unfavorable conclusions about the sponsor's product.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Conflict of interest in economic analyses of aromatase inhibitors in breast cancer: a systematic review

Jang

Chae

Haddad

et al. 2010

Breast Cancer Res Treat

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“…To complete our critical evaluation, we decided to analyse the potential influence of sponsors on the results of pharmacoeconomic studies, a controversial, highly debated issue in the literature worldwide [27][28][29]. All the 18 sponsored CMAs and the CBA showed positive results for the sponsored drugs, respectively lower costs and a positive difference between benefits and costs.…”

Section: Discussionmentioning

confidence: 99%

Pharmacoeconomic studies in Italy: a critical review of the literature

et al. 2006

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To assess the state of pharmacoeconomics in Italy we reviewed all the original studies published by Italian authors in national and international journals from January 1994 to December 2003. We selected 70 articles and broadly assessed 92 economic evaluations (EEs) since some articles contained multiple analyses. We adopted common analysis criteria to allow methodological comparison of the studies. The variables investigated can be grouped into three categories: general methods, costs, and consequences. To further assess the quality of the EEs, we decided to rank them according to criteria of both clinical and economic good practice. Then, to complete our critical evaluation, we analysed whether sponsorship might have somehow affected the results. Our analysis seems to support the widespread scepticism of the Italian NHS decision-makers towards pharmacoeconomic studies, whose results seem to be biased by flawed methods and sponsors' interference with results.

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“…Gli unici rimedi, ancorche per definizione parziali e insufficienti, per accrescere l'attendibilta degli studi di farmacoeconomia e disincentivare la pubblicazione di analisi di qualita modesta e viziate all'origine, appaiono tuttora quelli citati ampiamente in letteratura, quali: l'emanazione di linee guida nazionali da parte delle autorita pubbliche, l'adozione di meccanismi sempre piu rigorosi di peer reviewing da parte delle riviste scientifiche e la valutazione critica delle VE da parte di istituti indipendenti (Krimsky, 1999;Morgan et al, 2000;Rennie & Luft 2000). Adattando tali suggerimenti al caso specifico del nostro Paese, sembra a nostro avviso oramai imprescindibile la necessita di predisporre delle linee guida ufficiali di farmacoeconomia da parte dell'AIFA, auspicando che tale scelta favorisca la diffusione di un approccio metodologico piu rigoroso e omogeneo rispetto a quelli attualmente utilizzati.…”

Section: Cerzani El Alunclassified

Pharmacoeconomic evaluations on anti psychotics in schizophrenia: a review of the Italian studies

Cerzani¹,

Barbui

Garattini³

2006

Epidemiol Psichiatr Soc

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La schizofrenia e una grave patologia psichiatrica che produce effetti negativi non solo sulla salute, sul contesto professionale e sociale dei pazienti che ne sono affetti, ma anche sui caregivers che sono sottoposti a un elevato carico assistenziale (Magliano et al, 2002). Per quanto riguarda specificamente i trattamenti farmacologici, nell'ultimo decennio sono stati introdotti nuovi farmaci, i cosiddetti AntiPsicotici atipici (APa) che, teoricamente, dovrebbero presentare dei vantaggi terapeutici rispetto ai vecchi farmaci, i cosiddetti AntiPsicotici tipici (APt). Le sperimentazioni cliniche e le metanalisi fin qui condotte non hanno in realta completamente chiarito se gli APa presentino realmente un profilo di efficacia e tollerabilita superiore agli APt (Geddes et al, 2000;Davis et al, 2003;Leucht et al, 2003). A fronte di questi dati clinici che inducono cautela, il trattamento con gli APa comporta dei costi decisamente piu elevati (Percudani & Barbui, 2003); quest'ultima caratteristica ha favorito la produzione di numerosi studi di farmacoeconomia mirati a valutare il rapporto costo-efficacia di questi trattamenti nel contesto dell'assistenza psichiatrica.L'obiettivo principale della presente revisione della letteratura e quello di valutare criticamente l'appropriatezza della metodologia e la validita delle fonti informative delle Valutazioni Economiche (VE) pubblicate in Italia. MATERIALIE METODIGli studi di farmacoeconomia inclusi in questa analisi sono stati individuati attraverso una ricerca effettuata nelle banche dati Embase, Medline e nel database interno del CE-SAV; quest'ultimo costituisce il riferimento italiano per il progetto EURONHEED relativo al censimento di tutte le VE condotte in Europa . Gli articoli, selezionati nel periodo 1994-2004, dovevano soddisfare i requisiti di essere delle valutazioni economiche del trattamento farmacologico della schizofrenia scritte da Autori italiani e pubblicate in lingua italiana. Le parole chiave utilizzate nella ricerca sono state: "Analisi Costo-Efficacia", "Analisi Costo-Utilita, "Analisi Costo-Beneficio", "Analisi Minimizzazione Costi", "Schizofrenia", "Antipsicotici tipici", "Antipsicotici atipici" e "Italia".Sono stati selezionati cinque articoli (Rossi & Guidi, 2001;Tarricone, 2001;Ravasio et al, 2003;Mapelli et al., 2004;Mantovani et al, 2004) che soddisfacevano pienamente i requisiti sopra indicati. Utilizzando come riferimento la metodologia impiegata in una precedente revisione (Garattini et al, 2004), le variabili analizzate sono state suddivise in tre categorie: metodologia, costi e conseguenze terapeutiche. La figura 1 riassume sinotticamente lo schema metodologico utilizzato. ANALISI Aspetti generaliI cinque articoli selezionati con i suddetti criteri sono risultati pari a sette VE, dal momento che in due studi (Ravasio et al, 2003;Mapelli et al, 2004) sono state condotte due analisi distinte. La tabella I descrive sinteticamente i risultati dell'analisi metodologica applicata ai sette studi sottoposti a revisione. Tutte e sette le VE hanno...

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Conflict of Interest and Cost-effectiveness Analysis

Cited by 45 publications

References 18 publications

Conflict of interest in economic analyses of aromatase inhibitors in breast cancer: a systematic review

Conflict of interest in economic analyses of aromatase inhibitors in breast cancer: a systematic review

Pharmacoeconomic studies in Italy: a critical review of the literature

Pharmacoeconomic evaluations on anti psychotics in schizophrenia: a review of the Italian studies

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