Healthy Skepticism Library item: 10144
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Publication type: Journal Article
Hall WD, Lucke J.
Assessing the impact of prescribed medicines on health outcomes
Australia and New Zealand Health Policy 2007 Feb 15; 4:(1):epub
http://www.anzhealthpolicy.com/content/pdf/1743-8462-4-1.pdf
Abstract:
This paper reviews methods that can be used to assess the impact of medicine use on population
health outcomes. In the absence of a gold standard, we argue that a convergence of evidence from
different types of studies using multiple methods of independent imperfection provides the best
bases for attributing improvements in health outcomes to the use of medicines. The major
requirements are: good evidence that a safe and effective medicine is being appropriately
prescribed; covariation between medicine use and improved health outcomes; and being able to
discount alternative explanations of the covariation (via covariate adjustment, propensity analyses
and sensitivity analyses), so that medicine use is the most plausible explanation of the improved
health outcomes. The strongest possible evidence would be provided by the coherence of the
following types of evidence: (1) individual linked data showing that patients are prescribed the
medicine, there are reasonable levels of patient compliance, and there is a relationship between
medicine use and health improvements that is not explained by other factors; (2) ecological
evidence of improvements in these health outcomes in the population in which the medicine is
used. Confidence in these inferences would be increased by: the replication of these results in
comparable countries and consistent trends in population vital statistics in countries that have
introduced the medicine; and epidemiological modelling indicating that changes observed in
population health outcomes are plausible given the epidemiology of the condition being treated.
Notes:
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