Application of the principles of evidence-based medicine in programs to assess high-cost procedures and medications

Application of the Principles of Evidence-Based Medicine in Programs to Assess High-Cost Procedures and Medications UpdateDetermining the efficacy of treatments and procedures is of fundamental relevance, because economic resources are limited and, therefore, social priorities should be established 1 .Despite the benefit resulting from the continuous development of new drugs that reach clinical success, this process is frequently accompanied by elevation in costs due to the legitimate need for remuneration and return of investments in the area of pharmaceutical research.Physicians and private and public institutions responsible for providing health programs often have to face the dilemma of replacing or not medications already in use.Likewise, the dilemma of adding new drugs or not to traditional therapeutical protocols is frequently faced, with no spurious influence of interests void of scientific and ethical basis, aiming at obtaining a socially adequate cost/benefit ratio.The process by which changes in medical practice are introduced and authorized has undergone transformations in its fundaments 2 .Two major innovations, the randomized clinical trials and the guidelines provided by specialized medical societies, shifted the old emphasis on clinical application of the experience in individual practice to the use of scientific evidence-based norms.These essential tools that guide the best currently individualized medical practice should also be used to optimize the application of resources of the community in the issue in question, to guide the adoption of high-cost medications and procedures 3 .The practice of evidence-based medicine consists of harmonization and integration of the better external clinical evidence obtained through systematic research about studies specifically directed to obtaining conclusive results, which are usually gathered as guidelines/consensus, with

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