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Open Access Highly Accessed Debate

Health economics: the start of clinical freedom

José Antonio Sacristán*, María Costi, Amparo Valladares and Tatiana Dilla

Author Affiliations

Clinical Research Department. Eli Lilly and Company, Avenida de la Industria 30, Alcobendas, 28108 Madrid, Spain

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BMC Health Services Research 2010, 10:183  doi:10.1186/1472-6963-10-183

Published: 28 June 2010



Since Professor Hampton announced the death of clinical freedom in 1983, the increasing influence of Evidence-based Medicine and Health Technology Assessment has contributed to augment the feeling that clinicians have a secondary role in the therapeutic decision-making process.


This article constitutes a reflection on how clinicians may use the results of economic evaluations in their daily clinical practice, making decisions about cost-effectiveness on a case by case basis, and addressing both the patient's and society's needs. To that end, some illustrating examples are taken from the literature to show there are factors with great impact on cost-effectiveness results that can be easily identified and modified by clinicians.


The evolution of the discipline and the trend towards a tailored therapy suggest that health economics is not the end of clinical freedom but the start of it.