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March 16, 1990

Are Clinical Trials Cost-effective?

Author Affiliations

Health Care Financing Administration Washington, DC

Health Care Financing Administration Washington, DC

JAMA. 1990;263(11):1492. doi:10.1001/jama.1990.03440110053015

To the Editor.—  Dr Detsky1 provides a carefully designed analysis of how we might evaluate the cost-effectiveness of clinical trials in improving health. He argues, and Dr Fletcher2 seems to concur, that the evidence of cost-effectiveness is so overwhelming that policymakers would provide more money for research if they understood the evidence. As Dr Fletcher points out, Dr Detsky substantially overstates the cost-effectiveness of trials because he does not include the cost of providing the tested treatment. A more serious problem, however, is that neither considers the extent to which the results of the trials actually change medical outcomes.The impact of a clinical trial on outcomes tends to be limited by at least five factors: (1) physicians remain unaware of the results, (2) not all physicians agree as to what the trial "really" proved or whether the results are generalizable, (3) many physicians believe that changes in