Cost Minimization

Simply put, with cost minimization two equally effective strategies are compared in terms of cost, and the less-expensive strategy is chosen. Oftentimes, an assumption of equivalent efficacy of the two interventions must be made based on indirect evidence, that is, drug A and B are shown to have similar response rates, but in separate Phase II trials rather than head-to-head studies. Manufacturers are reluctant to design direct comparative studies for fear of losing market share should their product appear inferior.8 For example, dar-bepoietin and erythropoietin have not been directly compared in a large randomized trial until now, but available data indicate they are likely equivalent in the treatment of anemia; therefore, by the cost-minimization method, the less-expensive drug is preferable. This method is most useful when trying to choose between drugs in the same class, such as the hematopoietic growth factors just mentioned. However, assuming equivalent efficacy of drugs from different classes based on noncomparative studies would be fraught with bias.

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