Confusion from analyses and conflicts of interest

doi:10.1136/bmj.a2683

Published 25 November 2008, doi:10.1136/bmj.a2683
Cite this as: BMJ 2008;337:a2683

Letters

Guidance on osteoporosis

Confusion from analyses and conflicts of interest

The first 150 words of the full text of this article appear below.

The National Institute for Health and Clinical Excellence (NICE)is under heavy criticism for its osteoporosis guidelines.¹ TheNational Osteoporosis Society argues that many people who wouldbenefit from treatment are not treated and left with unnecessarilyand unethically high fracture risks.

The debate is, however, confused by the combination of two factors:the manipulability of cost effectiveness analyses and conflictsof interest.

Whether a drug is funded depends partly on estimates of healthgain relative to cost. Despite the existence of general guidelines,²cost effectiveness can be estimated in many different ways.The model used for health consequences, choice of data sources,inclusion or exclusion of certain costs, and other factors influencethe final results. Estimates for raloxifene, for example, differby a factor of 10.³ ⁴ Some of these differences arise from differencesin context, but much is the result of the choices made in theprocess.