Dutch guidelines for economic evaluation: ‘from good to better’ in theory but further away from pharmaceuticals in practice?

Conflict of interest disclosure: striking a balance?

“…We can just note again that intellectual interests are part of any scientific debate and inevitably emerge in comments. For instance, referring to our previous example of pharmacoeconomic models, our opinion that they are of scant utility for pricing and reimbursing drugs because of their intrinsic limits-so even when public agencies use them-clearly emerges in our articles on this subject [37,38,44].…”

Do European pharmacists really have to trespass on medicine?

“…On account of the scant clinical evidence, cost-effectiveness analyses focused on arguable trade-offs between the additional costs of clinical pharmacy services and potential savings on other healthcare services can only add further confusion [28]. Besides the intrinsic limits of any economic evaluation in healthcare [29], these studies suffer from a poor methodological design [30] and seem to be often induced by a political objective to demonstrate the usefulness of the local services provided [31]. However, it goes without saying that any pharmacist can provide a good clinical service regardless of the healthcare setting, just like any other health professionals who do their jobs in the interests of patients.…”

HTA for pharmaceuticals in Europe: will the mountain deliver a mouse?

“…Although HTA agencies always seek robust methods for REAs of drugs in clinical practice [33], the need of indirect comparisons inevitably arises when no head-to-head RCTs are available [30]. While REAs are based on clinical evidence-which should be global by definition-the main added value of CEAs should be costs, which are dramatically affected by domestic features, like clinical practice patterns and health care system frameworks, so CEA results can hardly be extrapolated from one setting to another [34]. That is why the EC guidance does not recommend European CEAs and leaves these analyses to single countries.…”

“…That is why the EC guidance does not recommend European CEAs and leaves these analyses to single countries. CEAs themselves do actually imply a multidisciplinary approach, adding economic and organizational aspects to the clinical ones needed for REAs [34]. In general, CEAs are still a young discipline in healthcare, and there is still disagreement on their methodology so different methods can lead to different results [14].…”