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October 6, 1989, Vol 262, No. 13 >
ARTICLE | October 6, 1989

Are Clinical Trials a Cost-effective Investment? FREE

Allan S. Detsky, MD, PhD
[+] Author Affiliations

Reprint requests to Toronto General Hospital, 200 Elizabeth St, EN G-246, Toronto, Ontario, Canada M5G 2C4 (Dr Detsky).


JAMA. 1989;262(13):1795-1800. doi:10.1001/jama.1989.03430130071037
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References

To assess the economic attractiveness of clinical research, this study measures the cost-effectiveness of seven selected randomized trials. The model considers the cost of performing a trial and the benefits to the health status of a target population one could expect before the trial was performed. The incremental cost-effectiveness for performing the trials ranged from a low of $2 to $3 per life-year saved for a trial of aspirin in unstable angina to a high of $396 to $685 per life-year saved for the randomized trial portion of the Coronary Artery Surgery Study. These ratios were substantially lower (ie, more economically attractive) than the cost-effectiveness ratios associated with performing interventions of proved effectiveness. This study shows that a selected group of clinical trials, some of which were controversial and expensive, were indeed a good investment. This information may be helpful to policymakers who consider allocating funds to biomedical research.

(JAMA. 1989;262:1795-1800)

REFERENCES

1 +
Detsky AS.  Using economic analysis to determine the resource consequences of choices made in planning clinical trials . J Chronic Dis. 1985;;38:753-765.
2 +
Weinstein M.  Cost-effectiveness of cancer prevention . Science. 1983;;221:17-23.
3 +
Thompson MS.  Decision-analytic determination of study size: the case of electronic fetal monitoring . Med Decis Making. 1981;;1:167-179.
4 +
Beck JR, Kassirer JP, Pauker SG.  A convenient approximation of life expectancy (the `DEALE') . Am J Med. 1982;;73:883-896.
5 +
L'Abbe KA, Detsky AS, O'Rourke K.  Metaanalysis in clinical research . Ann Intern Med. 1987;;107:224-233.
6 +
 The Lipid Research Clinics Program. The Coronary Primary Prevention Trial: design and implementation . J Chronic Dis. 1979;;32:609-631.
7 +
 Lipid Research Clinics Program. The Lipid Research Clinics Coronary Primary Prevention Trial results, I: reduction in incidence of coronary heart disease . JAMA. 1984;;251:351-364.
8 +
 CASS Principal Investigators and Their Associates. Coronary Artery Surgery Study (CASS): a randomized trial of coronary artery bypass surgery . Circulation. 1983;;68:939-950.
9 +
 Multiple Risk Factor Intervention Trial Research Group. Multiple Risk Factor Intervention Trial: risk factor changes and mortality results . JAMA. 1982;;248:1465-1477.
10 +
 The ISAM Study Group. A prospective trial of intravenous streptokinase in acute myocardial infarction (ISAM): mortality, morbidity, and infarct size at 21 days . N Engl J Med. 1986;;314:1465-1471.
11 +
Cairns JA, Gent M, Singer J, et al.  Aspirin, sulfinpyrazone, or both in unstable angina: results of a Canadian multicenter trial . N Engl J Med. 1985;;313:1369-1375.
12 +
Burroughs AK, Jenkins WJ, Sherlock S, et al.  Controlled trial of propranolol for the prevention of recurrent variceal hemorrhage in patients with cirrhosis . N Engl J Med. 1983;;309:1539-1542.
13 +
Stampfer MJ, Goldhaber SZ, Yusuf S, Peto R, Hennekens CH.  Effect of intravenous streptokinase on acute myocardial infarction: pooled results from randomized trials . N Engl J Med. 1982;; 307:1180-1182.
14 +
Detsky AS, Baker JP, O'Rourke K, Goel V.  Perioperative parenteral nutrition: a meta-analysis . Ann Intern Med. 1987;;107:195-203.
15 +
Weinstein MC, Stason WB.  Cost-effectiveness of interventions to prevent or treat coronary heart disease . Annu Rev Public Health. 1985;;6:41-63.
16 +
Goel V, Detsky AS.  A cost-utility analysis of pre-operative total parenteral nutrition . Int J Technol Assessment Health Care. 1989;;5:183-194.
17 +
Oster G, Epstein AM.  Cost-effectiveness of antihyperlipemic therapy in the prevention of coronary heart disease: the case of cholestyramine . JAMA. 1987;;258:2381-2387.
18 +
Liu P, Floras J, Haq A, Detsky A.  Cost-effectiveness evaluation of thrombolytic therapy: comparison of current modalities and identification of critical cost factors—a Canadian perspective . J Am Coll Cardiol. 1988;;11:186A.
19 +
Torrance GW.  Measurement of health state utilities for economic appraisal . J Health Econ. 1986;;5:1-30.
20 +
Weinstein MC.  Challenges for cost-effectiveness research . Med Decis Making. 1986;;6:194-198.
21 +
Goel V, Deber RB, Detsky AS.  Economic analysis and health policy development in the presence of the identifiable victim: the use of nonionic contrast media . Can Med Assoc J. 1989;;140:389-395.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Detsky AS.  Using economic analysis to determine the resource consequences of choices made in planning clinical trials . J Chronic Dis. 1985;;38:753-765.
2 +
Weinstein M.  Cost-effectiveness of cancer prevention . Science. 1983;;221:17-23.
3 +
Thompson MS.  Decision-analytic determination of study size: the case of electronic fetal monitoring . Med Decis Making. 1981;;1:167-179.
4 +
Beck JR, Kassirer JP, Pauker SG.  A convenient approximation of life expectancy (the `DEALE') . Am J Med. 1982;;73:883-896.
5 +
L'Abbe KA, Detsky AS, O'Rourke K.  Metaanalysis in clinical research . Ann Intern Med. 1987;;107:224-233.
6 +
 The Lipid Research Clinics Program. The Coronary Primary Prevention Trial: design and implementation . J Chronic Dis. 1979;;32:609-631.
7 +
 Lipid Research Clinics Program. The Lipid Research Clinics Coronary Primary Prevention Trial results, I: reduction in incidence of coronary heart disease . JAMA. 1984;;251:351-364.
8 +
 CASS Principal Investigators and Their Associates. Coronary Artery Surgery Study (CASS): a randomized trial of coronary artery bypass surgery . Circulation. 1983;;68:939-950.
9 +
 Multiple Risk Factor Intervention Trial Research Group. Multiple Risk Factor Intervention Trial: risk factor changes and mortality results . JAMA. 1982;;248:1465-1477.
10 +
 The ISAM Study Group. A prospective trial of intravenous streptokinase in acute myocardial infarction (ISAM): mortality, morbidity, and infarct size at 21 days . N Engl J Med. 1986;;314:1465-1471.
11 +
Cairns JA, Gent M, Singer J, et al.  Aspirin, sulfinpyrazone, or both in unstable angina: results of a Canadian multicenter trial . N Engl J Med. 1985;;313:1369-1375.
12 +
Burroughs AK, Jenkins WJ, Sherlock S, et al.  Controlled trial of propranolol for the prevention of recurrent variceal hemorrhage in patients with cirrhosis . N Engl J Med. 1983;;309:1539-1542.
13 +
Stampfer MJ, Goldhaber SZ, Yusuf S, Peto R, Hennekens CH.  Effect of intravenous streptokinase on acute myocardial infarction: pooled results from randomized trials . N Engl J Med. 1982;; 307:1180-1182.
14 +
Detsky AS, Baker JP, O'Rourke K, Goel V.  Perioperative parenteral nutrition: a meta-analysis . Ann Intern Med. 1987;;107:195-203.
15 +
Weinstein MC, Stason WB.  Cost-effectiveness of interventions to prevent or treat coronary heart disease . Annu Rev Public Health. 1985;;6:41-63.
16 +
Goel V, Detsky AS.  A cost-utility analysis of pre-operative total parenteral nutrition . Int J Technol Assessment Health Care. 1989;;5:183-194.
17 +
Oster G, Epstein AM.  Cost-effectiveness of antihyperlipemic therapy in the prevention of coronary heart disease: the case of cholestyramine . JAMA. 1987;;258:2381-2387.
18 +
Liu P, Floras J, Haq A, Detsky A.  Cost-effectiveness evaluation of thrombolytic therapy: comparison of current modalities and identification of critical cost factors—a Canadian perspective . J Am Coll Cardiol. 1988;;11:186A.
19 +
Torrance GW.  Measurement of health state utilities for economic appraisal . J Health Econ. 1986;;5:1-30.
20 +
Weinstein MC.  Challenges for cost-effectiveness research . Med Decis Making. 1986;;6:194-198.
21 +
Goel V, Deber RB, Detsky AS.  Economic analysis and health policy development in the presence of the identifiable victim: the use of nonionic contrast media . Can Med Assoc J. 1989;;140:389-395.

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