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- Page navigation anchor for RE: Embracing the science of value in healthRE: Embracing the science of value in health
To,
The Editor
Canadian Medical Association JournalDear Ma’am/Sir
We read with interest the paper by Krahn and colleagues in the July edition of the journal.(1) We agree with their arguments on the scientific value of Cost-Effectiveness Analysis (CEA) and the broad need to incorporate CEA in clinical guideline development and public health decision making.We suggest that we need to go one step further by mandating cost-effectiveness analysis for all clinical trials funded by governmental payers as part of the original study design. Several research funding agencies across the world (e.g. NIHR / MRC in the UK) already strongly encourage this. (2)(3) The Medical Research Council document in fact explicitly states that “An economic evaluation should be included if at all possible, as this will make the results far more useful for decision-makers”. In 2005, the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) published the ‘Good Research Practices for cost-effectiveness analysis alongside Clinical Trials’ report. This has since been updated in 2014.(4) This report offers several useful directions to researchers on trial design, data management, analysis and reporting from a CEA framework and we believe this serves as a readily available template for researchers and policy makers.
In our own sphere of expertise (critical care medicine) several examples of such joint economic evaluations exist [the PRaCTICaL(5) a...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Value in measurement in health careRE: Value in measurement in health care
We MDs are a major health care resource. It is therefore important that the national distribution of MDs in all fields is appropriate for Canada's needs, which is not the case at this time. Province by province health care and health care value measurement would therefore be much more valuable.
In my view, after 48 years of practice and teaching, physician remuneration needs to be divided more appropriately among all fields of practice. The present disproportionate emphasis on procedural practice for maximum remuneration across the country should be abandoned, in favour of making sure that enough MDs in all fields are then 1) more equably remunerated than is presently the situation, and 2) in practice in all parts of all provinces.Competing Interests: None declared. - Page navigation anchor for RE: value measurement in health careRE: value measurement in health care
In 2002 I presented a paper to the Canadian Psychiatric Association AGM titled:” Psychotherapy with psychotic patients- Efficacy and cost effectiveness.”
They completely ignored my reporting that psychotic patients who had had decades of hospitalizations and drugs could be better treated with insight oriented psychotherapy, which was more effective and more cost effective.
I also outlined the research showing that the science behind the drugs was defective, and our epidemic of mental illnesses has escalated since drugs have become the main treatment for emotional disorders.
I will be happy to email you a copy of my 2002 paper, as well as a more recent article I’ve written about this disturbing mistake of not developing psychotherapy for emotionally disturbed people.Competing Interests: None declared.