Brussels Meeting Notes

Medicines, genetics and the justification of cost-effectiveness analysis

Follow up notes 3/12/06

Argument Not sure that focussing the argument on pharmacogenomics is the best way forward’. Though it is a reasonable example

Really the argument now is how need should be defined—assuming that public health systems do exist to provide access to treatment according to need

“How is this different from subgroups in trials’ the reply (should have been)—If subgroups from trials have the same need (as I have defined it) then it is not different. If different need then different treatment is justified. Some confusion with how I had defined need; economist preference for need as capacity to benefit from healthcare by cost. This seems to lead directly to a sole focus on efficiency. The paper, if there is a paper in this, is on how equity concerns are obfuscated by how need is defined (i.e. capacity to benefit from healthcare per $).

A second paper—closer to the PhD—is in regard to the problems which current RCT analysis (focused on classical statistics) presents a problem for sound economic analysis. A number of presentations relied on bayesian approaches but are hampered, I think, by the clinical efficacy inputs being that of classical statistics. There is also a second issue around finding evidence for pharmacogenomic/genomic technologies, by their nature they are not amenable to classical statistics.