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Healthy Skepticism Library item: 19497

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.


Publication type: Journal Article

Jarvinen TLN, Sievanen H, Kannus P, Jokihaara J, Khan KM
The true cost of pharmacological disease prevention
BMJ 2011 Apr 20; 342:


In this analysis article, the authors argue that, despite widespread use of preventive drugs such as statins, antihypertensives and bisphosphonates, there is no valid evidence that they represent value for money. While large, randomised clinical trials are considered to represent the strongest form of evidence in assessing whether a particular healthcare intervention works, little attention has been paid to the fact that people treated in large multicentre randomised trials may not accurately reflect the population receiving the drug in real world settings. For example, a study by van Staa et al. compared the cost-effectiveness of avoiding adverse gastrointestinal event by switching patients from conventional NSAIDs to COX 2 inhibitors as derived from randomised trial data (about GBP 12,500 per blled prevented) with that derived from an analysis using the UK General Practice Research Database, comprising anonymised medical records of GPs (about GBP 65,000 per bleed prevented).


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