Modeling Imaginary Worlds: Version 4 of the AMCP Format for Formulary Submissions
The question of demarcation between normal science and pseudoscience is critical to the discovery of new facts. The core elements supporting progress in science are: (i) empirically evaluable coherent theories and (ii) the testing of hypotheses through experimentation or systematic observation. If modeled or simulation-based claims for cost-effectiveness are to be accepted as a credible input to health care decision making than they must conform to these standards. Claims should be testable, falsifiable and replicable. If not then they are best seen as pseudoscience. This assessment of the latest version of the Academy of Managed Care Pharmacy (AMCP) Format for Formulary Submissions (Version 4.0; April 2016) concludes that, in their recommendations for cost-effectiveness modeling, the proposed standards do not meet those of normal science. Rather, in common with previous versions of the AMCP Format, the modeling framework proposed not only puts to one side the issue of testable claims, but supports the modeling of imaginary worlds or thought experiments where claims are immune to falsification. In consequence, the payer or other recipient of a modeled or simulated claim that follows the AMCP Format has no idea, in the absence of observation or experimentation, whether the claim is right or even if it is wrong. The claims are potentially misleading, possibly harmful, but to an unknown extent. They have no place in evidence-based medicine.Conflict of Interest
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