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Another possible solution is to have half the study sponsored by the drug company that makes the newer, more expensive agent and the other half financed by the government insurer, which has an interest in promoting lower-cost drugs.
TMZ, a newer and more expensive agent, is given in a 5 consecutive day regimen every 28 days.
Thus, a more expensive agent may be a very efficient alternative if it is associated with greater efficacy or better tolerance than a less expensive option.
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Some microorganisms have become resistant to drugs, requiring a continuing search for different (and often more expensive) agents.
There is no reason not to start with the least expensive agent for a clinical trial before moving to more expensive agents.
It will be interesting to observe whether newer short-acting but more expensive agents (for instance, remifentanil and dexmedetomidine) are chosen for sedation in the future.
In comparison, the estimated cost of administering aspirin is around £110 000 per year (less than 1% of the more expensive agents).
This is due mainly to handling (2 mg ampoule) and costs, because lorazepam is one of the more expensive agents in Germany for sedation.
Poorer countries such as Vietnam could benefit by avoiding a rush to newer, more expensive agents if sensitivity to older drugs could be demonstrated.
More expensive agents may be useful with regard to overall costs because the length of stay in the ICU may be reduced, as was shown by Barrientos-Vega and colleagues [ 33] and Dahaba and colleagues [ 34].
Factors that drive increases in pharmaceutical expenditures can be divided into increases in price or in volume (i.e. more users and/or longer durations of therapy), and changes in utilization patterns that favour newer, more expensive agents over older, less expensive yet perhaps equally effective alternatives [ 64].
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com