The success of researchers in developing innovative and effective medicines has produced a healthier and older population, as well as an observable shift in expenditure towards pharmaceuticals. In contrast to drug expenditures, patented drug prices have actually shown an average annual decrease of 0.5% since 1988. While we agree cost-effectiveness evaluation is a useful input into the decision-making process of drug benefit managers, it is but one consideration, and it is imperative that governments look beyond drug budgets to the broader benefits of innovative drug therapy to Canadians, both economically and clinically. The lead paper makes a number of suggestions regarding clinical trials that would lead to an increased demand on the developers of innovative medicines, all of which would raise the development costs of drugs while reducing the spectrum of available agents. This commentary argues that focusing greater attention on ensuring the appropriate use of medicines, with less concentration on restricting Canadians' access to effective drugs available in other countries, will yield the greatest benefits to the health of our population. Patient health management is a strategy that deserves a closer look to achieve this goal.

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