1
|
Smith J, Ellins J, Sherlaw-Johnson C, Vindrola-Padros C, Appleby J, Morris S, Sussex J, Fulop NJ. Rapid evaluation of service innovations in health and social care: key considerations. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-47. [PMID: 37796483 DOI: 10.3310/btnu5673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (RSET: 16/138/17; BRACE: 16/138/31).
Collapse
Affiliation(s)
- Judith Smith
- Health Services Management Centre, School of Social Policy, University of Birmingham, Edgbaston, Birmingham, UK
| | - Jo Ellins
- Health Services Management Centre, School of Social Policy, University of Birmingham, Edgbaston, Birmingham, UK
| | | | | | | | - Stephen Morris
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jon Sussex
- RAND Europe, Westbrook Centre, Cambridge, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, London, UK
| |
Collapse
|
2
|
Plöderl M, Hengartner MP. Effect of the FDA Black Box Suicidality Warnings for Antidepressants on Suicide Rates in the USA. CRISIS 2023; 44:128-134. [PMID: 34915730 DOI: 10.1027/0227-5910/a000843] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Some authors claimed that the US Food and Drug Administration (FDA) black box warning on treatment-emergent suicidality with antidepressants in adolescents (issued 2004) and young adults (issued 2006) led to an increase of suicides, based on the analyses of ecological data with debatable assumptions about putative changes in suicide rates. Aims: To explore if putative changes in suicide rates in adolescents and young adults at the time of the FDA warnings is a detectable signal in the data or compatible with random fluctuations. Method: We applied different changepoint analyses for adolescent and young adult suicide rates from 1981 to 2019 in the USA. Results: Changepoint analysis did not support a detrimental effect of the FDA black box warnings. The downward trend of suicides reversed several years after the warning in adolescents (2007-2009) and many years before in young adults (1999-2001). Limitations: Our analyses cannot rule out detrimental effects of the FDA warnings. However, even if there was such an effect, it was likely small and indistinguishable from random fluctuations in the available suicide data. Conclusion: There is no detectable change of trend in adolescent or young adult suicide rates in line with a detrimental effect of the FDA black box warnings on treatment-emergent suicidality.
Collapse
Affiliation(s)
- Martin Plöderl
- Department of Crisis Intervention and Suicide Prevention, University Clinic for Psychiatry, Psychotherapy, and Psychosomatics, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Austria
| | | |
Collapse
|
3
|
Ye S, Wang R, Zhang B. Comparison of estimation methods and sample size calculation for parameter-driven interrupted time series models with count outcomes. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2022. [DOI: 10.1007/s10742-021-00267-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
4
|
Zhang B, Liu W, Lemon SC, Barton BA, Fischer MA, Lawrence C, Rahn EJ, Danila MI, Saag KG, Harris PA, Allison JJ. Design, analysis, power, and sample size calculation for three-phase interrupted time series analysis in evaluation of health policy interventions. J Eval Clin Pract 2020; 26:826-841. [PMID: 31429175 PMCID: PMC7028460 DOI: 10.1111/jep.13266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/01/2019] [Accepted: 08/06/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To discuss the study design and data analysis for three-phase interrupted time series (ITS) studies to evaluate the impact of health policy, systems, or environmental interventions. Simulation methods are used to conduct power and sample size calculation for these studies. METHODS We consider the design and analysis of three-phase ITS studies using a study funded by National Institutes of Health as an exemplar. The design and analysis of both one-arm and two-arm three-phase ITS studies are introduced. RESULTS A simulation-based approach, with ready-to-use computer programs, was developed to determine the power for two types of three-phase ITS studies. Simulations were conducted to estimate the power of segmented autoregressive (AR) error models when autocorrelation ranged from -0.9 to 0.9 with various effect sizes. The power increased as the sample size or the effect size increased. The power to detect the same effect sizes varied largely, depending on testing level change, trend changes, or both. CONCLUSION This article provides a convenient tool for investigators to generate sample sizes to ensure sufficient statistical power when three-phase ITS study design is implemented.
Collapse
Affiliation(s)
- Bo Zhang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Wei Liu
- School of Management, Harbin Institute of Technology, Harbin, Heilongjiang, China
| | - Stephenie C Lemon
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Bruce A Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Melissa A Fischer
- Department of Internal Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Foundation, and Fallon Community Health Plan, Worcester, Massachusetts
| | - Colleen Lawrence
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth J Rahn
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Maria I Danila
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kenneth G Saag
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Paul A Harris
- Department of Biomedical Informatics and Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Jeroan J Allison
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| |
Collapse
|
5
|
Liu W, Ye S, Barton BA, Fischer MA, Lawrence C, Rahn EJ, Danila MI, Saag KG, Harris PA, Lemon SC, Allison JJ, Zhang B. Simulation-based power and sample size calculation for designing interrupted time series analyses of count outcomes in evaluation of health policy interventions. Contemp Clin Trials Commun 2019; 17:100474. [PMID: 31886433 PMCID: PMC6920506 DOI: 10.1016/j.conctc.2019.100474] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/08/2019] [Accepted: 10/14/2019] [Indexed: 11/27/2022] Open
Abstract
Objective The purpose of this study was to present the design, model, and data analysis of an interrupted time series (ITS) model applied to evaluate the impact of health policy, systems, or environmental interventions using count outcomes. Simulation methods were used to conduct power and sample size calculations for these studies. Methods We proposed the models and analyses of ITS designs for count outcomes using the Strengthening Translational Research in Diverse Enrollment (STRIDE) study as an example. The models we used were observation-driven models, which bundle a lagged term on the conditional mean of the outcome for a time series of count outcomes. Results A simulation-based approach with ready-to-use computer programs was developed to calculate the sample size and power of two types of ITS models, Poisson and negative binomial, for count outcomes. Simulations were conducted to estimate the power of segmented autoregressive (AR) error models when autocorrelation ranged from −0.9 to 0.9, with various effect sizes. The power to detect the same magnitude of parameters varied largely, depending on the testing level change, the trend change, or both. The relationships between power and sample size and the values of the parameters were different between the two models. Conclusion This article provides a convenient tool to allow investigators to generate sample sizes that will ensure sufficient statistical power when the ITS study design of count outcomes is implemented.
Collapse
Affiliation(s)
- Wei Liu
- School of Management, Harbin Institute of Technology, Harbin, Heilongjiang 150001, China
| | - Shangyuan Ye
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, 02115, USA
| | - Bruce A Barton
- School of Management, Harbin Institute of Technology, Harbin, Heilongjiang 150001, China
| | - Melissa A Fischer
- Department of Internal Medicine, University of Massachusetts Medical School, Worcester, MA, 01605, USA.,Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Foundation, and Fallon Community Health Plan, Worcester, MA, 01605, USA
| | - Colleen Lawrence
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Elizabeth J Rahn
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Maria I Danila
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Kenneth G Saag
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Paul A Harris
- Department of Biomedical Informatics and Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37203, USA
| | - Stephenie C Lemon
- School of Management, Harbin Institute of Technology, Harbin, Heilongjiang 150001, China
| | - Jeroan J Allison
- School of Management, Harbin Institute of Technology, Harbin, Heilongjiang 150001, China
| | - Bo Zhang
- Department of Neurology and ICCTR Biostatistics and Research Design Center, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02215, USA
| |
Collapse
|
6
|
Abstract
Sequential analysis can be used as an early warning system about potential unintended consequences of health policy decisions, generating follow-up investigations, but it should not be used as causal evidence.
Collapse
|
7
|
Lu CY, Soumerai SB. Comment on ‘Measuring the impact of medicines regulatory interventions - systematic review and methodological considerations’ by Goedecke et al
. Br J Clin Pharmacol 2018; 84:2167-2168. [DOI: 10.1111/bcp.13659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/27/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Christine Y. Lu
- Department of Population Medicine; Harvard School and Harvard Pilgrim Health Care Institute; Boston MA USA
| | - Stephen B. Soumerai
- Department of Population Medicine; Harvard School and Harvard Pilgrim Health Care Institute; Boston MA USA
| |
Collapse
|
8
|
Abstract
Despite the good intentions of the Food and Drug Administration (FDA), many drug warnings are ineffective or have unintended consequences, particularly if the media exaggerates the messages and scares the public. The controversial 2003 to 2004 FDA warnings on youth suicidality associated with antidepressant use are a case in point. In a 10-year interrupted time series (ITS) analysis in 11 health plans, we found that the warnings and hyped media coverage led to substantial reductions in antidepressant use (declines in antidepressant use and overall care corroborated in several studies), and small, visible increases in emergency room and inpatient poisonings with psychotropic drugs. In a gross misunderstanding of the method, Dr Stone calls ITS, "an intuition based upon false analogies, fallacious assumptions and analytical error." We demonstrate visually using published studies that the ITS method is one of the oldest (hundreds of years) and strongest quasi-experimental study designs, and that the alternative data analyses proposed by Dr Stone do not have rates (denominators), nor baselines, so the measures of change are invalid.
Collapse
Affiliation(s)
- Christine Y Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Gregory Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Stephen B Soumerai
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| |
Collapse
|
9
|
An Introduction to the Point/Counter-Point/Reply Exchange by Dr Stone and Professor Lu and Colleagues. Med Care 2018; 56:373-374. [PMID: 29634628 DOI: 10.1097/mlr.0000000000000894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|