Decision-makers' use of pharmacoeconomics: what does the research tell us?

Governments, organizations and industry routinely make decisions regarding the value of pharmaceuticals. The perspectives, techniques, decision constraints and available information differ across these decision-makers and sometimes within categories. Although pharmacoeconomics is consistent with the international trend toward evidence-based decisions in medicine and could benefit all of these decision-makers, the potential impact of these studies has been largely unrealized. Why is it that a field to which so much research funding has been devoted, has produced so little of clear use to major decision-makers? Would inflexible organizational barriers surrounding narrowly defined performance incentives and line item budget accountability limit the usefulness of even impeccably performed pharmacoeconomic studies? Or, are methodological and logistical considerations impeding the usefulness of pharmacoeconomics?