The Drug Effectiveness Review Project (DERP), a collaboration of fifteen states and two private organizations led by former Oregon governor John Kitzhaber (D), should incorporate cost-effectiveness considerations into its evidence-based reviews of drug classes, writes Peter Neumann in an article published June 6 on the Health Affairs Web site. "The DERP decision to ignore cost-effectiveness considerations reveals a society still unable to consider economic factors openly in evidence reviews," says Neumann. His article is the lead piece of a five-paper Health Affairs package on the DERP that surveys many of the controversies surrounding the project.

Virtually all new psychotropic drugs in recent years have had positive marginal benefits for at least some patients, Haiden Huskamp says in the March/April Health Affairs. She notes that the value of new entrants is likely to be greater, and price competition less potent, in drug classes that treat relatively heterogeneous conditions such as mental illness. Huskamp also points out, though, that the cost-benefit analysis is likely to vary across drugs and patients, and she says that the Food and Drug Administration should consider requiring drugmakers to compare their products to other drugs in the relevant class, not just to a placebo, as a condition for FDA approval.

Between 1991-92 and 1999-2000, the percentage of adult hospice users age eighty-five and older increased from 14 percent to 26 percent, and the percentage with noncancer diagnoses rose from 20 percent to 37 percent, Beth Han and coauthors report in the May/June Health Affairs. The share of adult hospice users with seven or fewer days of service increased fourteen percentage points over the same period, and the researchers call for further examination of how this shift to shorter stays has affected the quality of hospice care. Overall, the total number of hospice users tripled between 1991-92 and 1999-2000; even so, only about 25 percent of Americans who died in 2000 utilized hospice care.