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Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor
To the Editor: Mr Friedberg and colleagues1 take a systematic approach to identifying the characteristics
of published cost studies. However, relying on study sponsorship as the dominant
criterion for evaluating potential conflict of interest may be too simplistic.
A more thorough review of methods, data inputs, assumptions, and publication
sources and their impact on study conclusions is warranted. For example, prospective,
randomized clinical studies (single center or multicenter) using actual use
and cost data may be less biased than studies developed using decision analysis
models. Additionally, some of the studies included in the analysis were not
published in peer-reviewed journals. To combine heterogeneous samples in drawing
conclusions is improper both in clinical research and the evaluation of conflict
Furthermore, in more than 10% of cases in which authors were contacted
regarding potential conflicts, authors and/or publishers failed to report
industry relationships. Therefore, it can be difficult for readers to fully
understand potential sources of conflict of interest unless disclosure and
reporting policies are standardized and enforced.
In evaluating the potential for biases, it may be more prudent for readers
to evaluate clinical and economic literature across several criteria including
sponsorship, author affiliation, journal type, study methods and assumptions
and the extent to which authors' conclusions and statements are supported
by the data presented. Rather than focusing solely on pharmaceutical industry
sponsorship, perhaps the best advice should be caveat lector (let the reader beware).
Prendergast MM. Sources of Bias in the Economic Analysis of New Drugs. JAMA. 2000;283(11):1423–1424. doi:10.1001/jama.283.11.1421
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