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The enthusiasm of researchers and clinical investigators is an admirable and perhaps necessary trait for performing good clinical research but must not obscure the interpretation of trial results. Cost-effectiveness analysis is being promoted as an objective means to measure the balance between the effectiveness of a treatment and its cost. Although cost-effectiveness analysis in medicine is in its infancy, much work has been performed to solidify its methodological underpinnings.1-3 Clinicians, nevertheless often remain suspicious of the process as they realise how difficult it may be to have reliable cost and efficacy information.
This issue contains an article by Aristides and colleagues on the cost-effectiveness of abciximab in preventing restenosis following percutaneous transluminal coronary angioplasty (PTCA).4 We agree wholeheartedly with the caveats expressed by Glasziou in his accompanying editorial5 and add some further worries in this commentary.
The key ratio in cost-effectiveness analysis has a numerator of costs and a denominator that measures clinical efficacy such as years of life saved. In assessing the efficacy of an intervention it is necessary to consider critically the totality of the evidence. Aristides et al have relied only on the data from the 2009 patients enrolled in EPIC,6 ,7 although referring to the results of the more recent EPILOG8 and CAPTURE9 trials to …