Paying the Piper for Pharmacoeconomic Studies

In their landmark article that introduced the medical community to methods of cost-effectiveness analysis, Weinstein and Stason did not mention who they thought would pay for the studies.’ In retrospect, perhaps they should have. Two decades later, debates about funding arrangements and the independence of investigators seem to occupy almost as much time among policymakers as the results of cost-effectiveness analyses themselves. This phenomenon is at once curious, unsettling, and, at least at some level, unanticipated: after all, results from clinical trials, which are routinely funded by pharmaceutical manufacturers, have long been accepted in the same community. Despite years of serious scholarship and vast improvements in the field, cost-effectiveness analysis-and its younger, more well-heeled cousin, 'pharmacoeconomics -remain hampered by a lingering perception that study results reflect the hidden biases of industry sponsors, and that the field owes more to marketers than to scientists.’ This essay reviews key issues on the topic and outlines some policy options for the future. While the remarks focus on the experience in the United States, they should also apply in a variety of international contexts.