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Biomedical subjects

N Freemantle

Publications and source records attributed to N Freemantle.

At least 19 recordsLinked to original sources
PubMed1996

Lessons from international experience in controlling pharmaceutical expenditure. III: Regulating industry.

This is the third of three papers that review international policies to control spending on drugs and to improve the efficiency of drug use. This paper reviews policies regulating the supply of drugs, particularly licensing and reimbursement controls, price and profit regulation. Price and profit controls contain few incentives for improving cost effective use of drugs, and focus on cost containment and profitability of domestic industry. Carefully monitored economic evaluation could lead to improvements in efficiency and benefits to patients and the health care system.

Cost-Benefit Analysis↗
PubMed1996

Lessons from international experience in controlling pharmaceutical expenditure. II: Influencing doctors.

This is the second of three papers that review international policies to control spending on drugs and to improve the efficiency of drug use. This paper reviews policies influencing doctors' prescribing of drugs--particularly the use of budgetary restrictions, information and feedback, and guidelines--and evaluates the impact of these policies. Studies evaluating incentive systems are limited, but evidence suggests that providing information on its own will not lead to substantial changes in practice and that more active strategies should be evaluated.

Budgets↗
PubMed1996

Lessons from international experience in controlling pharmaceutical expenditure. I: Influencing patients.

This is the first of three papers to review international policies to control spending on drugs and improve the efficiency of drug use. Policies can target three main groups: patients, prescribing doctors, and the drugs industry. In this paper we examine policies aimed at patients, particularly restrictions on reimbursement (such as prescription charges). Rigorous experimental and quasi-experimental studies suggest that policies to limit the level of reimbursement of drugs reduce the use of essential as well as non-essential drugs and may do more harm than good.

Attitude to Health↗
PubMed1995

Dealing with uncertainty: will science solve the problems of resource allocation in the U.K. NHS?

In spite of the huge efforts which internationally address the development and assessment of health technologies, the majority of health care interventions have not been formally evaluated for their effectiveness and their likely impact upon health status is largely unknown. This has led to a situation where it is unclear on what basis a health care system might be judged, or for that matter on what basis decisions on the specification of individual services might be made. It has frequently been argued that the only way to build an adequate understanding of the effectiveness of different interventions is through systematically locating and synthesising the available evidence from research, and such systematic overviews are increasingly available in many areas. However, such overviews produce few clear conclusions, and even when the results of systematic overviews show unequivocal benefits for patients, implementing the findings of such reviews remains problematic. Research evidence provides useful information on marginal benefits for patients, though areas where the absolute benefit is high appear to be very rare. The most common finding appears to be uncertainty. Interpreting research evidence is complex, and even very clear findings may prove hard to operationalise. Good quality research will help, but will not solve, the problems of resource allocation in the NHS or in other health systems.

Adrenal Cortex Hormones↗
PubMed1995

Assisted conception techniques. On what basis do health technologies become routinely available when they have been assessed as effective?

The possibility of restoring fertility among some infertile couples through assisted reproductive technology has led to questions about the terms under which such treatments should be made available. Although there is now evidence on their effectiveness, there is considerable variation in the availability of these treatments under the U.K. National Health Service.

Diffusion of Innovation↗
PubMed1994

Prescribing selective serotonin reuptake inhibitors as strategy for prevention of suicide.

OBJECTIVE: To evaluate a policy to reduce the incidence of suicide by means of changing the prescribing of antidepressants from the older tricyclic antidepressants to the routine first line use of selective serotonin reuptake inhibitors or newer tricyclic and related antidepressants. DESIGN: Cost effectiveness analysis with sensitivity analyses using observational data on costs, volume of prescribing, deaths, and toxicity. SETTING: United Kingdom primary care. INTERVENTIONS: Selective serotonin reuptake inhibitors or newer tricyclic and related antidepressants compared with the use of older tricyclics. MAIN OUTCOME MEASURES: Cost per life saved and cost per life year saved. RESULTS: The potential number of lives which may be saved from a switch to the routine first line use of selective serotonin reuptake inhibitors is between 300 and 450 each year. The cost per life year gained ranges from 19,000 pounds to 173,000 pounds, depending on the assumptions used. The cost per life year gained through the use of the newer tricyclic and related antidepressants is considerably lower. CONCLUSIONS: The cost per life year gained through avoiding suicides by the routine first line use of serotonin reuptake inhibitors is likely to be high. The new tricyclics and related drugs are of similar toxicity to the serotonin reuptake inhibitors but are considerably cheaper and so are most cost effective for this purpose. Further research is required on such prescribing. Because of the great uncertainties the shift to considerably more expensive options must be further investigated.

Antidepressive Agents, Tricyclic↗
PubMed1993

Selective serotonin reuptake inhibitors: meta-analysis of efficacy and acceptability.

OBJECTIVE: To examine the evidence for using selective serotonin reuptake inhibitors instead of tricyclic antidepressants in the first line treatment of depression. DESIGN: Meta-analysis of 63 randomised controlled trials comparing the efficacy and acceptability of selective serotonin reuptake inhibitors with those of tricyclic and related antidepressants. MAIN OUTCOME MEASURES: Improvement in mean scores on Hamilton depression rating scale for 53 randomised controlled trials. Pooled drop out rates from the 58 trials which reported drop out by treatment group. RESULTS: Among the 20 studies reporting standard deviation for the Hamilton score no difference was found in efficacy between serotonin reuptake inhibitors and tricyclic and related antidepressants (standardised mean difference 0.004, 95% confidence interval -0.096 to 0.105). The difference remained insignificant when the remaining 33 studies that used the 17 item and 21 item Hamilton score were included by ascribing weighted standard deviations. The odds ratio for drop out rate in patients receiving serotonin reuptake inhibitors compared with those receiving tricyclic antidepressants was 0.95 (0.86 to 1.07). Similar proportions in both groups cited lack of efficacy as the reason for dropping out but slightly more patients in the tricyclic group cited side effects (18.8% v 15.4% in serotonin reuptake group). CONCLUSIONS: Routine use of selective serotonin reuptake inhibitors as the first line treatment of depressive illness may greatly increase cost with only questionable benefit.

Antidepressive Agents, Tricyclic↗