The relationship between drug costs and treatment choices was the subject of the first annual Drug and Therapeutics Bulletin symposium held in March 1993.* In a time of severe financial constraints for the NHS it is important that the money available is well spent. In the case of treatment that means the benefits must be worth the cost. There is, however, no agreed way of deciding when a particular health benefit to an individual is worth the cost to the NHS. Drug prices are easier to measure and more consistent than the prices of other treatments, and may be more amenable to cost-benefit analysis. Treatment choices are made primarily by doctors but with critical input from patients, pharmacists, nurses and health service managers. In this article we give an overview of the symposium at which speakers described ways in which drug costs and treatment choices were tackled in general practice (Ann McPherson, John Howie), in hospital (Dorothy Anderson), in clinical research and audit (Iain Chalmers, Alison Frater), by consumers (Anna Bradley), by health economists (Mike Drummond) and by government (Joe Collier). We also take into account points raised in discussion by the participants.
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