In an article published June 6 on the Health Affairs Web site, Peter Neumann provides a comprehensive review of the issues facing the Drug Effectiveness Review Project (DERP), a collaboration of fifteen states and two private organizations led by former Oregon governor John Kitzhaber (D). In four Perspectives on Neumann's paper:

DERP staffers Mark Gibson and John Santa, MD, say the DERP avoids cost-effectiveness analysis because of "methodological uncertainties," but states factor in costs when they use the DERP's findings in their Medicaid decision making;

Newell McElwee and other officials of the drugmaker Pfizer Inc. warn that DERP reviews must be used with caution in making coverage determinations to avoid hurting patients who differ from the average;

Alan Heaton, director of pharmacy for Blue Cross and Blue Shield of Minnesota, notes that using evidence-based principles to pick superior products within drug classes risks giving manufacturers of anointed products unwarranted pricing leverage;

and Steve Findlay, managing editor of Consumer Reports Best Buy Drugs, notes that his online project publishes DERP findings alongside cost information and chooses "best buy" drugs using both objective data and peer reviewers' subjective judgments.

Trends in mental health spending during the 1990s broadly track trends in overall health care spending, Benjamin Druss writes in the May/June issue of Health Affairs. Like overall spending, mental health spending appears to be yielding a good return in the aggregate, but vulnerable populations and areas of waste and poor quality remain concerns. Druss reports that, between 1990-91 and 2003, the proportion of the population receiving mental health services rose from 12.2 to 20.1 percent, almost entirely due to increases in the use of psychotropic drugs.