Details

Autor(en) / Beteiligte

• McPhail, Steven M

Titel

Economic evaluations in ‘non-inferiority’ trials: can costs guide decisions between surgical and non-surgical interventions?

Ist Teil von

• British journal of sports medicine, 2020-06, Vol.54 (12), p.695-696

Ort / Verlag

England: BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine

Erscheinungsjahr

2020

Quelle

BMJ Journals

Beschreibungen/Notizen

• Some surgeons’ resistance to de-implementation of surgical interventions like APM may be, at least in part, due to the nature of clinical training and surgeons’ perceptions of favourable outcomes among their own patients, as well as professional renown or financial gain in healthcare systems that value and reward surgical activity rather than patient outcomes.3 I commend the many surgeons, broader multidisciplinary teams and health system administrators who have been willing to lead the way and disinvest from APM where appropriate. In some regions of the world there has been a substantial reduction in APM activity among older patients who are not likely to yield significant benefits from the procedure.4 In this editorial I highlight some further nuances of van de Graaf and colleagues’2 economic evaluation in the context of the broader field of disinvestment research, non-inferiority trials and low-value care. In many countries5 even comparatively paltry savings per unit may lead individuals or health services to choose to purchase a generic ahead of a brand name medicine6 because they consider an additional cost of even €1 or €2 to be an inferior choice. There has been abundant long-standing empirical research investigating minimally important differences in health-related quality of life measures (from which QALYs are most often derived).7 However, QALYs inherently include both valuation of health states and the time over which those health states are experienced.