Gaps in the evaluation and monitoring of new pharmaceuticals: proposal for a different approach

The marked increase in spending on drugs has led payers such as provincial governments to restrict funding for many drugs to specific clinical indications that are thought to be cost-effective. Some have argued that this unreasonably deprives patients of access to beneficial drugs. In this article we argue for a new approach to drug evaluation in Canada that combines the strengths of randomized trials and observational studies, and places more emphasis on the use of drug evaluation after marketing for decision-making.