Search PubMed⌕ Search

Biomedical subjects

N Freemantle

Publications and source records attributed to N Freemantle.

At least 91 records · Page 5Linked to original sources
PubMed1998

The dilemma of new drugs. Are costs rising faster than effectiveness?

This century has seen a phenomenal growth in the development, understanding and use of pharmaceuticals. Additionally, this period has seen the balance of the treatment needs of patients shift dramatically from infectious to cardiovascular and cancer diseases, and from infancy and middle-age to old age. The value of modern pharmaceuticals to society is undoubted. However, the benefits in terms of health gain, when adequately evaluated, are often more modest than first supposed, and are often achieved at considerable costs and sometimes considerable risks to patients. Data are seldom adequate to attempt a robust evaluation of the cost effectiveness of drugs and compare how cost effectiveness may have changed over time. Rapid increases in development costs coupled with the increasing focus on chronic and old-age diseases make it probable that the cost effectiveness of new drugs is broadly declining, but such a conclusion should be interpreted with caution. The big challenge for the next century with its likely genetic and biotechnological discoveries, bringing as yet unforeseen benefits, risks and costs, is to radically improve the manner in which new drugs are evaluated and diffuse into health systems.

Drug Approval↗
PubMed1997

Publication bias in clinical trials and economic analyses.

Publication bias is an established notion in the clinical literature; essentially, large studies or positive results are more likely to find their way into the public domain than small studies or negative results. Meta-analysis presents a focus for the problems of publication bias, seeking to summarise the evidence in a particular therapeutic area by retrieving and analysing all available clinical studies. Economic analyses are also vulnerable to publication bias, and at 3 levels: first, in the health-outcomes data available for modelling (resulting from publication bias in the clinical literature); second, in the motivations for conducting an economic analysis; and third, in repeating the process of seeking publication.

Clinical Trials as Topic↗
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↗
PubMed1996

Are decisions taken by health care professionals rational? A non systematic review of experimental and quasi experimental literature.

Systematic overviews of the effectiveness and cost effectiveness of health care interventions are increasingly available, and yet there has been relatively little attention upon putting their important findings into practice. Furthermore, close attention to the decision making behaviour of health professionals in situations of uncertainty indicates that this may not always be 'rational'. This paper examines developments in the understanding of rationality in decision making from outside the health care setting, particularly the interesting work on 'regret theory', and begins to apply this framework to health care.

Cost-Benefit Analysis↗
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↗