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Murmurs from the heart (or why the stethoscope is not an economic tool)
  1. M ARISTIDES,
  2. M GLIKSMAN
  1. M-TAG,
  2. PO Box 5639,
  3. NSW 2057, Australia
  4. Eli Lilly Austalia,
  5. 112 Wharf Road,
  6. West Ryde,
  7. NSW 2114, Australia
    1. N RAJAN
    1. M-TAG,
    2. PO Box 5639,
    3. NSW 2057, Australia
    4. Eli Lilly Austalia,
    5. 112 Wharf Road,
    6. West Ryde,
    7. NSW 2114, Australia

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      We thank Drs Sleight and Brophy for their challenging editorial on our ReoPro cost-effectiveness study. The editorial raises several important issues to which we would like to reply. In general, we agree that publication bias can exist with cost-effectiveness studies but remind our critics that this is a potential problem with all scientific research. Further, we accept that the long term outcomes of patients given ReoPro were unclear as we had only six month efficacy data. That was why we performed a two-step analysis with cost-effectiveness data from the pivotal study presented first, followed by an analysis to explore the impact on long term outcomes.

      The trial based analysis is not flawed in its scope or because of selection bias. The EPIC trial was concerned with specific indications that were not fully examined in the other two studies mentioned (CAPTURE and EPILOG). Further, no accounting error has been made. The modelled analysis aimed to explore the long term outcomes with ReoPro and indicated cost-effective event free survival and overall survival. Three year follow up data of EPIC patients have since been published and have shown significant improvement in event free survival and, despite limited statistical power for individual end points, a trend to reduced mortality (odds ratio 0.78; 95% confidence intervals (CI) 0.53 to 1.14).

      We defend the focus on the EPIC trial and clarify that the results of the other clinical trials were …

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