New BMJ policy on economic evaluations

This week we publish an economic evaluation of screening for abdominal aortic aneurysms.¹ It is based on a randomised trial. At the same time the Lancet is publishing the clinical results.² Unfortunately this is a common pattern—for the Lancet to publish the clinical results and us to publish the economic evaluation. We have decided that this can't continue. We will now consider for publication economic evaluations based on clinical trials only if the clinical results are submitted to us as well. This is partly petulance, but we think our policy is reasonable.

The clinical world has been sceptical about economic evaluations, worrying that it is too easy for sponsors, particularly pharmaceutical companies, to get the results they want. Evidence shows that many economic evaluations have been of low quality.³ But both of these things are also true of randomised trials: many have been of low quality,⁴ and pharmaceutical companies often conduct them for marketing rather than scientific reasons. With a better understanding of methods and the arrival of guidelines, the quality of both randomised trials and economic evaluations is probably improving.⁵,⁶

The BMJ has long believed that tough choices must be made in health care.⁷ Not all effective treatments can be afforded. We also believe that it is a good thing to base such choices on the evidence supplied by economic evaluations. This is not a radical position. The National Institute for Clinical Excellence (NICE), for example, believes the same, and the Medical Research Council has for years wanted randomised trials to be accompanied by economic evaluations. The BMJ has thus long been willing to publish economic evaluations and publishes more than most medical journals.

Many medical journals are more interested in straightforward clinical trials than they are in economic evaluations. This is understandable: their readers are doctors, not economists. There is an argument, however, that says that a clinical trial that shows that a treatment is effective is in some ways an inadequate economic evaluation. It is providing evidence to suggest that a treatment should be used—and yet gives no evidence on costs. It's like a shop window without prices. Anybody thinking of introducing a new treatment in a health system with limited resources (every system) must consider the costs as well as the benefits.

There is thus a strong argument for keeping clinical and economic results together. That's what we want to do. Send us your clinical and economic results together, and we will be delighted. Send somebody else your clinical results and us your economic results, and we will send them back, politely.

Papers p 1135