Rheumatology Advance Access originally published online on October 1, 2003
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Rheumatology 2004; 43: 4-6
© British Society for Rheumatology 2003; all rights reserved
Editorial |
Do rheumatology cost-effectiveness analyses make sense?
University of Kansas School of Medicine, Wichita, 1Arthritis Research Center Foundation, Wichita, Kansas and 2Vanderbilt University School of Medicine, Nashville, Tennessee, USA
Correspondence to: F. Wolfe, National Data Bank for Rheumatic Diseases, Arthritis Research Center Foundation, 1035 N. Emporia, Suite 230, Wichita, KS 67214, USA. E-mail: fwolfe@arthritis-research.org
| The first 150 words of the full text of this article appear below. |
In this issue of Rheumatology, Brennan et al. [1] describe the cost-effectiveness (CE) of one of the most important and effective treatments in rheumatology, etanercept. They do it in an article that represents the state of the art of rheumatology CE analyses. Their work is transparent, careful, thoughtful and insightful: a model for others working in this field. CE analyses have influenced NICE (National Committee on Clinical Excellence; www.nice.org.uk) and have had a profound effect on rheumatology treatment options in the UK and elsewhere. This encomium notwithstanding, we think the premises of this and similar studies may be untenable. We offer these criticisms in the spirit of scientific inquiry.
Rheumatology CE studies use a mixture of data from randomized clinical trials (RCTs), observational studies and extrapolations. From extrapolations of RCT results, we then estimate long-term costs and effectiveness in the non-randomized setting of clinical practice.
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