With the growing international literature in economic evaluation and the rapid international spread of health technologies, there is a need to undertake, or at least interpret, economic evaluations at an international level.
The pharmaceutical industry is used to gathering data on the efficacy and safety of its products. Here the prior assumption is that the performance of a medicine is largely unaffected by differences between settings. Cost-effectiveness data for medicines may not be so easily transferable, however. They may be affected by differences in the availability of alternative treatments, in clinical practice patterns, in relative prices and in the incentives to healthcare professionals and institutions. One jurisdiction where cost-effectiveness data are required formally, Australia, has pointed out that data need to be relevant to local circumstances.
This paper examines these issues, with particular reference to the treatment of acid-related diseases. The reasons why cost-effectiveness data may vary by setting are examined in depth, the published literature is reviewed to assess the comparative cost-effectiveness of products across countries, and some recommendations are made about the conducting and interpretation of economic studies on the international level.