Intended for healthcare professionals

Letters Cost of preventive drugs

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BMJ 2011; 342 doi: (Published 24 May 2011) Cite this as: BMJ 2011;342:d3198
  1. Peter N Trewby, consultant physician1
  1. 1Darlington Memorial Hospital, Darlington, County Durham DL3 6HX, UK
  1. peter.trewby{at}

I commend an alternative, but perhaps more patient centred, interpretation of the Cochrane hierarchy of evidence described by Järvinen and colleagues.1 The first rungs on the ladder—“Can it work?” and “Does it work?”—are answered by the science underlying the intervention and the controlled trial. But the third rung—“Is it worth it?”—should not be asked first of health economists …

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