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Promise of Real-World Evidence for Patient Centricity in Gulf Cooperation Council Countries: Call to Action. Drugs Real World Outcomes 2022; 10:1-9. [PMID: 36394823 PMCID: PMC9944129 DOI: 10.1007/s40801-022-00336-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 11/18/2022] Open
Abstract
Presently, Gulf Cooperation Council countries are lagging in the generation of real-world data and use of real-world evidence for patient-centered care compared with the global average. In a collaborative effort, experts from multiple domains of the healthcare environment from the Gulf Cooperation Council countries came together to present their views and recommended key action points for the generation of robust real-world data and leveraging real-world evidence in the countries. The opinions of the experts are presented, along with existing barriers to the effective generation of real-world evidence in the countries. The Gulf Cooperation Council countries are undergoing transformative changes paving the way for improved healthcare measures; however, the challenges in generating reliable, robust, accessible, and secure real-world evidence are persistent. Hence, ongoing public-private engagements, as well as collaborations between regulators, policymakers, healthcare professionals, insurance and pharmaceutical companies, and patients, are warranted. A few notable examples of real-world evidence studies highlighting the benefits of real-world evidence for gaining valuable insights into patient-centric decision making are also discussed. The actionable steps identified for successful real-world evidence generation would provide long-term, real-world evidence-based patient-centric benefits for the countries.
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Kamusheva M, Németh B, Zemplényi A, Kaló Z, Elvidge J, Dimitrova M, Pontén J, Tachkov K, Mitkova Z. Using real-world evidence in healthcare from Western to Central and Eastern Europe: a review of existing barriers. J Comp Eff Res 2022; 11:905-913. [PMID: 35726611 DOI: 10.2217/cer-2022-0065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
As part of the HTx (Next Generation Health Technology Assessment) project, this study was aimed at identifying the main barriers for application of real-world evidence (RWE) for the purposes of health technology assessment in the Central and Eastern European countries. A mixed methods approach was employed to identify the main barriers: a scoping review of the literature and a series of discussions with stakeholders. Based on the applied approaches, we attempted to summarize the main barriers and challenges related to transferability of RWE in five main groups: technical, regulatory, clinical, scientific and perceptional barriers. Further research should pursue the development of detailed, consensus-based guidelines to improve the harmonization and standardization of RWE.
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Affiliation(s)
- Maria Kamusheva
- Department of Organization & Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | | | - Antal Zemplényi
- Syreon Research Institute, Budapest, Hungary.,Division of Pharmacoeconomics, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary.,Centre for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Jamie Elvidge
- Science, Evidence & Analytics Directorate, National Institute for Health & Care Excellence (NICE), Manchester, UK
| | - Maria Dimitrova
- Department of Organization & Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Johan Pontén
- Dental & Pharmaceutical Benefits Agency, Stockholm, Sweden
| | - Konstantin Tachkov
- Department of Organization & Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Zornitsa Mitkova
- Department of Organization & Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
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McNair D, Lumpkin M, Kern S, Hartman D. Use of RWE to Inform Regulatory, Public Health Policy, and Intervention Priorities for the Developing World. Clin Pharmacol Ther 2021; 111:44-51. [PMID: 34655224 PMCID: PMC9298255 DOI: 10.1002/cpt.2449] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 10/05/2021] [Indexed: 12/28/2022]
Abstract
For low‐ and middle‐income countries (LMICs) to benefit from real‐world evidence (RWE)/real‐world data (RWD) in both product registration (“regulatory”) decision making and in product utilization policy (“policy”) decision making, they need to overcome several challenges. They need to deploy more electronic health records systems (EHRs), adjust for confounder variables, build trust between stakeholders, and create laws and regulations for local generation of data that are assented for secondary use. The role of procurers and their use of RWE/RWD in the LMIC context likewise is in a state of ongoing development. Procurers of health products are strong players currently in the “access” chain as LMICs continue to work on strengthening governmental health technology assessment (HTA) bodies. Procurers’ use of RWE is presently at an early stage and is mostly indirect, leveraging RWE results that are produced by researchers in high‐income countries (HICs), often under considerably different regulatory and policy objectives and constraints compared to LMICs’ epidemiology and priorities. Pending wider deployment of EHRs and other RWE sources, stakeholders must realize that populations from HIC RWE (i) can be devised to closely resemble phenotypic patterns in LMIC populations and (ii) can be analyzed to align with LMICs’ unmet needs.
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Affiliation(s)
- Douglas McNair
- Global Health, Integrated Development, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Murray Lumpkin
- Global Health, Integrated Development, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Steven Kern
- Global Health, Integrated Development, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Daniel Hartman
- Global Health, Integrated Development, Bill & Melinda Gates Foundation, Seattle, Washington, USA
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Petracci F, Ghai C, Pangilinan A, Suarez LA, Uehara R, Ghosn M. Use of real-world evidence for oncology clinical decision making in emerging economies. Future Oncol 2021; 17:2951-2960. [PMID: 34044583 DOI: 10.2217/fon-2021-0425] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Real-world evidence (RWE) can provide insights into patient profiles, disease detection, treatment choice, dosing strategies, treatment sequencing, adverse event management and financial toxicity associated with oncology treatment. However, the full potential of RWE is untapped in emerging economies due to structural and behavioral factors. Structural barriers include lack of regulatory engagement, real-world data availability, quality and integrity. Behavioral barriers include entrenched healthcare professional behaviors that impede rapid RWE understanding and adoption. These barriers can be addressed with close collaboration of healthcare stakeholders; of whom, regulators need to be at the forefront given their ability to facilitate use of RWE in healthcare policy and legislation.
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Affiliation(s)
- Fernando Petracci
- Breast Cancer Department, Instituto Alexander Fleming, Avenida Crámer 1180 Ciudad Autónoma de Buenos Aires. C.P. 1426, Argentina
| | - Chirag Ghai
- IQVIA, Real World Evidence Strategy and Solutions, New York, NY 10282, USA
| | - Andrew Pangilinan
- IQVIA, Real World Evidence Strategy and Solutions, New York, NY 10282, USA
| | | | | | - Marwan Ghosn
- Hematology & Oncology Department, Hotel Dieu de France University Hospital & Saint Joseph University, Beirut, Lebanon
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Zhou YL, Zhang YG, Zhang R, Zhou YL, Li N, Wang MY, Tian HM, Li SY. Population diversity of cardiovascular outcome trials and real-world patients with diabetes in a Chinese tertiary hospital. Chin Med J (Engl) 2021; 134:1317-1323. [PMID: 33734138 PMCID: PMC8183749 DOI: 10.1097/cm9.0000000000001407] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recent cardiovascular outcome trials (CVOTs) changed the therapeutic strategy of guidelines for type 2 diabetes. We compared the characteristics of patients from real-world hospital settings with those of participants in recent pragmatic randomized trials. METHODS This electronic medical record (EMR)-based retrospective observational study investigated the data of patients with diabetes from inpatient and outpatient settings in West China Hospital of Sichuan University from January 1, 2011, to June 30, 2019. We identified patients meeting the inclusion criteria of a pragmatic randomized trial (EMPA-REG OUTCOME) based on EMRs and compared their baseline characteristics with those of the trial participants. The cutoff for the clinical significance of each characteristic was set as its minimal clinically important difference based on expert consultation. RESULTS We included 48,257 inpatients and 36,857 outpatients with diabetes and found that 8389 (17.4%) inpatients and 2646 (7.2%) outpatients met the inclusion criteria for the EMPA-REG OUTCOME trial. Compared with the trial population, the real-world inpatients meeting the eligibility criteria of the EMPA-REG OUTCOME had similar age, blood pressure, and lipid profiles but comprised of fewer males, metformin users, anti-hypertensive drug users, and aspirin users, and had a lower body mass index. The group of outpatients meeting the eligibility criteria had fewer males, similar age, fewer metformin users, fewer insulin users, fewer anti-hypertensive drug users, and fewer aspirin users compared with the trial population. CONCLUSIONS The trial population in EMPA-REG OUTCOME represents only a small portion of patients with diabetes from the inpatient and outpatient departments of a Chinese tertiary medical center. Evidence localization in different clinical settings and validation are essential to enabling extrapolation of the results from CVOTs in patients with diabetes to Chinese clinical practice.
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Affiliation(s)
- Yi-Ling Zhou
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Yong-Gang Zhang
- Cochrane China Center, MAGIC China Center, Chinese Evidence-based Medicine Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Rui Zhang
- The Informatic Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - You-Lian Zhou
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Nan Li
- The Informatic Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Mi-Ye Wang
- The Informatic Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Hao-Ming Tian
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - She-Yu Li
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Cochrane China Center, MAGIC China Center, Chinese Evidence-based Medicine Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Engineering Research Center for Medical Information Technology, Ministry of Education, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
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Abdul-Khalek RA, Abu-Sitta G, El Achi N, Kayyal W, Elamine A, Noubani A, Menassa M, Ahmed F, Sullivan R, Mukherji D. Mapping breast cancer journal publications in conflict settings in the MENA region: a scoping review. Ecancermedicalscience 2020; 14:1129. [PMID: 33209120 PMCID: PMC7652545 DOI: 10.3332/ecancer.2020.1129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Indexed: 01/22/2023] Open
Abstract
Background Breast cancer is a major cause of cancer-related morbidity and mortality among women in the the Middle East and North Africa (MENA) region. Conflict and political instability in the region may affect medical research output, including that on breast cancer. This scoping review aims to systematically identify and map breast cancer publications across different stages of the cancer care pathway and across conflict-affected countries within the MENA region. The findings of this work will highlight the impact of conflict on cancer research that could be mitigated with the proper contextualised capacity strengthening intervention. Methods We followed the PRISMA-Scr methodology. We searched for peer-reviewed publications on topics related to breast cancer in 11 databases: Medline, PubMed, EMBASE, Web of Science, PROQUEST, CINAHL, Global Index Medicus, Arab World Searches Complete, Popline, Scopus and Google Scholar using both controlled vocabulary and keywords. Publication abstracts and full-text versions were screened for duplicates and included in our study based on pre-specified eligibility criteria: focused on breast cancer, related to the specific country of analysis and human or health system studies. We used a structured data extraction form to extract information related to the article, its methodology and the cancer care pathway being studied. Results A total of 19,215 citations were retrieved from our search. After removing duplicates, a total of 8,622 articles remained. Title and abstract screening retained 1,613 articles. Publications with first author affiliations to Turkey were consistently the highest across all categories of the cancer care pathway. Trends show an increase in articles from Lebanon, Jordan and Palestine after 2015. Early exploratory and epidemiological studies represented the majority of breast cancer research, followed by policy and implementation research and lastly experimental research. Most research conducted followed an observational study design. Important gaps were identified in the research output related to advanced breast cancer and palliative care (Libya, Syria and Yemen), mental health (Libya), and knowledge and education of breast cancer (Libya and Syria). Conclusion This scoping review has identified key areas in breast cancer research that lack significant research activity in conflict MENA settings. These areas, including but are not limited to palliative care, mental health, and education, can be prioritised and developed through regional collaboration and contextualised capacity strengthening initiatives.
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Affiliation(s)
- Rima A Abdul-Khalek
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Ghassan Abu-Sitta
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Nassim El Achi
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Walaa Kayyal
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Ahmad Elamine
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Aya Noubani
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Marilyne Menassa
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Fahad Ahmed
- Institute of Oncology, Hacettepe University, Ankara, Turkey
| | - Richard Sullivan
- King's Health Partners Comprehensive Cancer Centre and Institute of Cancer Policy, King's College London, London, UK
| | - Deborah Mukherji
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
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