Pharmacoeconomics and pharmacoepidemiology: curious bedfellows or a match made in heaven?

Pharmacoepidemiology is an established subdiscipline of epidemiology concerned with estimating the efficacy, effectiveness and safety of pharmaceutical products. Pharmacoeconomics is an established subdiscipline of health economics concerned with the evaluation of pharmaceutical products in terms of their value for money. Despite a common focus on the evaluation of pharmaceuticals, practitioners in the two disciplines appear to work largely in isolation of each other, as evidenced by lines of reasoning developed in one field that do not appear in the other. The purpose of this paper is to explore the interface between pharmacoepidemiology and pharmacoeconomics with the aim of identifying the potential synergies that exist from greater communication of ideas between practitioners in both disciplines. Issues are illustrated by means of a simple example of safety and efficacy in deep vein thrombosis prophylaxis. Issues surrounding safety and efficacy exemplify the need for a framework that allows trade-off between such benefits and risks of drug therapy. Health economics provides such a framework and it is suggested that those working in pharmacoepidemiology might make more of this framework in seeking to address essential trade-offs and inform policy. Similarly, it is argued that pharmacoeconomics could benefit from the robust methods of estimation used in epidemiological research as part of evaluation studies, in particular surrounding issues of unbiased estimation and scale of measurement. A closer working relationship between the disciplines could allow for economic assessment to be made earlier in the product cycle, which could bring benefits to society in terms of delaying the uptake of cost-ineffective products and speeding the uptake of products offering clear value for money.