Intended for healthcare professionals


Economic evaluation and clinical trials: size matters

BMJ 2000; 321 doi: (Published 02 December 2000) Cite this as: BMJ 2000;321:1362

The need for greater power in cost analyses poses an ethical dilemma

  1. Andrew Briggs (, Joint MRC/Southeast Region training fellow
  1. Health Economics Research Centre, Institute of Health Sciences, University of Oxford, Oxford OX3 7LF

    General practice pp 1383, 1389

    Randomised trials of health care interventions are increasingly attempting to tackle issues of cost effectiveness as well as clinical effectiveness. A good example of this appears in the two papers describing the clinical1 and economic evaluation2 of psychological therapies in primary care in this issue of the BMJ (pp 1383,1389). The use of clinical trials as a vehicle for prospective cost effectiveness analysis presents challenges for successful evaluation, and the methods of conducting trial based economic evaluation are still in their infancy.

    Several commentators have emphasised that health economists should be involved from the outset in the design of trials that seek to report on cost effectiveness,3 rather than being asked to add in the economic variables as an adjunct to the main trial (in a so called “piggyback” arrangement).4 The reason for this is because design considerations are different for clinical and economic analyses.

    The tendency of resource use variables to follow a skewed distribution5 means …

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