PharmacoEconomics
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The cost of drugs in the UK has increased at a rate of 4% above inflation over the last ten years. Prescribing in general practice accounts for 80% of the total drugs bill. Within general practice, there is considerable variation in individual prescribing frequency and costs, reflecting demographic, morbidity and professional influences. ⋯ It is too early to judge whether it will be a success. After initial resistance, many doctors are adopting the principles of the scheme and are critically reviewing their prescribing. Greater awareness of the content and influences on prescribing in primary care and of the resource implications for the rest of the NHS of rational prescribing has encouraged dialogue between hospital clinicians, managers and general practitioners.
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Four recent questionnaires for measuring the quality of life of patients with respiratory disease (Chronic Respiratory Disease Questionnaire, St George's Respiratory Questionnaire, Living with Asthma Questionnaire, and Asthma Quality of Life Questionnaire) differ in the content and style of the items used. Differences in content arise over the use or emphasis on symptom items, functional limitation (activity) items, and emotion items. These differences stem in part from the different methods used for item selection and refinement, which include selecting the most 'important' items, qualitative analysis for clarity, ratings of distress, and psychometric analysis. Despite these differences, there is considerable evidence for content validity of all four questionnaires. Because quality of life is so poorly developed as a theoretical construct, the demonstrable statement that all 4 questionnaires have construct validity provides little information about the questionnaires.
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Meta-analysis is an important part of assessing cost-effectiveness in that it may help determine which treatments are indeed effective and estimate the level of effectiveness of each. Meta-analysis uses the data from all the relevant trials and is a powerful tool for detecting effects too small to be picked up by individual trials. The assessment of quality of studies in a meta-analysis is critical, with priority needing to be given to high quality randomised studies. ⋯ Nevertheless, problems can arise when meta-analysis is used for cost-effectiveness analysis, due to variation in study medication protocols, duration of follow-up, and difficulties in interpreting patient subgroups and compliance. Despite being subject to the design flaws of both the trials analysed and the methods used in the analysis itself, meta-analysis provides a more objective and thorough means of evaluating effectiveness and hence the cost-effectiveness of treatments. Based on the meta-analysis evidence, we recommend that the current QALY league tables be split into an implementation table for clearly effective therapies, and a research priority table where the evidence of treatment effectiveness is less clear and more research is needed.