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October 18, 2000

Problems in Pharmacoeconomic Analyses—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(15):1922-1924. doi:10.1001/jama.284.15.1921

In Reply: Mr Stafford's main criticism appears to be that the conclusions of our study have been biased by a government or health system perspective and the authors' involvement in various aspects of the decision-making process (listing drugs on the Australian Pharmaceutical Benefits Schedule).

During the study, recommendations to the Australian federal health minister regarding which drugs in the schedule should be subsidized were made by 2 advisory committees comprising more than 20 members. Assessments of companies' submissions were made by a group of 16 evaluators. We analyzed the evaluations and the committees' reviews systematically, using objective criteria. The results and conclusions reflect the views of a wide group of professionals involved in the evaluation process and not just those of the authors. While our article undoubtedly reflects the experiences of those who purchase or subsidize the use of pharmaceuticals (rather than those who manufacture them), we do not think this has a bearing on the main conclusions of the article, which are that pharmacoeconomic analyses are valuable, but complex and error prone, that each analysis requires detailed evaluation to avoid critical errors, and that traditional peer-review standards are unlikely to lead to detection of many of these problems.

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