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Davies-Teye BB, Medeiros M, Chauhan C, Baquet CR, Mullins CD. Pragmatic patient engagement in designing pragmatic oncology clinical trials. Future Oncol 2021; 17:3691-3704. [PMID: 34337970 DOI: 10.2217/fon-2021-0556] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Oncology trials are the cornerstone of effective and safe therapeutic discoveries. However, there is increasing demand for pragmatism and patient engagement in the design, implementation and dissemination of oncology trials. Many researchers are uncertain about making trials more practical and even less knowledgeable about how to meaningfully engage patients without compromising scientific rigor to meet regulatory requirements. The present work provides practical guidance for addressing both pragmaticism and meaningful patient engagement. Applying evidence-based approaches like PRECIS-2-tool and the 10-Step Engagement Framework offer practical guidance to make future trials in oncology truly pragmatic and patient-centered. Consequently, such patient-centered trials have improved participation, faster recruitment and greater retention, and uptake of innovative technologies in community-based care.
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Affiliation(s)
- Bernard Bright Davies-Teye
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA.,The PATIENTS Program, University of Maryland, Baltimore, MD 21201, USA
| | - Michelle Medeiros
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA.,The PATIENTS Program, University of Maryland, Baltimore, MD 21201, USA
| | - Cynthia Chauhan
- The PATIENTS Program, University of Maryland, Baltimore, MD 21201, USA
| | - Claudia Rose Baquet
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA.,The PATIENTS Program, University of Maryland, Baltimore, MD 21201, USA
| | - C Daniel Mullins
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA.,The PATIENTS Program, University of Maryland, Baltimore, MD 21201, USA
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2
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April MD, Murray BP. Cost-effectiveness Analysis Appraisal and Application: An Emergency Medicine Perspective. Acad Emerg Med 2017; 24:754-768. [PMID: 28295894 DOI: 10.1111/acem.13186] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/16/2017] [Accepted: 03/04/2017] [Indexed: 12/21/2022]
Abstract
Cost-effectiveness is an important goal for emergency care delivery. The many diagnostic, treatment, and disposition decisions made in the emergency department (ED) have a significant impact upon healthcare resource utilization. Cost-effectiveness analysis (CEA) is an analytic tool to optimize these resource allocation decisions through the systematic comparison of costs and effects of alternative healthcare decisions. Yet few emergency medicine leaders and policymakers have any formal training in CEA methodology. This paper provides an introduction to the interpretation and use of CEA with a focus on application to emergency medicine problems and settings. It applies a previously published CEA to the hypothetical case of a patient presenting to the ED with chest pain who requires risk stratification. This paper uses a widely cited checklist to appraise the CEA. This checklist serves as a vehicle for presenting basic CEA terminology and concepts. General topics of focus include measurement of costs and outcomes, incremental analysis, and sensitivity analysis. Integrated throughout the paper are recommendations for good CEA practice with emphasis on the guidelines published by the U.S. Panel on Cost-Effectiveness in Health and Medicine. Unique challenges for emergency medicine CEAs discussed include the projection of long-term outcomes from emergent interventions, costing ED services, and applying study results to diverse patient populations across various ED settings. The discussion also includes an overview of the limitations inherent in applying CEA results to clinical practice to include the lack of incorporation of noncost considerations in CEA (e.g., ethics). After reading this article, emergency medicine leaders and researchers will have an enhanced understanding of the basics of CEA critical appraisal and application. The paper concludes with an overview of economic evaluation resources for readers interested in conducting ED-based economic evaluation studies.
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Affiliation(s)
- Michael D. April
- Department of Emergency Medicine; San Antonio Uniformed Services Health Education Consortium; San Antonio TX
| | - Brian P. Murray
- Department of Emergency Medicine; San Antonio Uniformed Services Health Education Consortium; San Antonio TX
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Goldberger JJ, Basu A, Boineau R, Buxton AE, Cain ME, Canty JM, Chen PS, Chugh SS, Costantini O, Exner DV, Kadish AH, Lee B, Lloyd-Jones D, Moss AJ, Myerburg RJ, Olgin JE, Passman R, Stevenson WG, Tomaselli GF, Zareba W, Zipes DP, Zoloth L. Risk stratification for sudden cardiac death: a plan for the future. Circulation 2014; 129:516-26. [PMID: 24470473 DOI: 10.1161/circulationaha.113.007149] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Jeffrey J Goldberger
- Department of Medicine-Cardiology (J.J.G., A.H.K., R.P.), Department of Preventive Medicine (D.L.-J., R.P.), and Weinberg College of Arts and Sciences and Medical Humanities and Bioethics (L.Z.), Northwestern University, Chicago, IL; Department of Health Services and Pharmacy, University of Washington, Seattle (A.B.); National Institutes of Health, Washington DC (R.B.); Cardiovascular Institute, Beth Israel Deaconess Medical Center, Boston, MA (A.E.B.); Department of Medicine, University at Buffalo, The State University of New York, Buffalo (M.E.C., J.M.C.); Krannert Institute of Cardiology, Indiana University, Indianapolis (P.-S.C., D.P.Z.); Cardiac Electrophysiology Research, Cedars-Sinai Medical Center, Los Angeles, CA (S.S.C.); Summa Health System Cardiovascular Institute, Cleveland, OH (O.C.); CON-ECT Clinical Coordinating Centre, Calgary, Alberta, Canada (D.V.E.); Department of Medicine, University of California, San Francisco (B.L., J.E.O.); Department of Medicine (A.J.M.), and Department of Medicine Cardiology (W.Z.), University of Rochester Medical Center, Rochester, NY; Department of Medicine, University of Miami Health System, Miami, FL (R.J.M.); Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (W.G.S.); and Department of Medicine, The Johns Hopkins University Baltimore, MD (G.F.T.)
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Hao Y, Thomas A. Health technology assessment and comparative effectiveness research: a pharmaceutical industry perspective. Expert Rev Pharmacoecon Outcomes Res 2014; 13:447-54. [PMID: 23977973 DOI: 10.1586/14737167.2013.815401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We briefly review the characteristics of several established health technology assessment (HTA) programs in industrialized societies including Germany, the UK and France. Special attention is paid on two issues: the position of HTA in coverage decision making and the role of economic assessment in evaluation processes. Although law makers in the USA have barred the use of NICE's cost/quality-adjusted life year or similar health economics approaches by public payers for coverage decision making, there are suggestions of prioritizing relative efficacy evaluation over economic assessment under a comparative effectiveness research (CER) framework to inform payment rates of public payers (an approach similar to German and French HTA processes). However, such an approach is unlikely to prove viable. It should also be noted that, if cost considerations are made explicit in US CER policy decisions, CER may become an unsustainable approach undermined by a conflicting emphasis on both cost containment and a demand for costly comparative evidence. On the other hand, properly designed CER initiatives can serve as a facilitator of more efficient research activities and drug development models. With these points in mind, the likely pathway of US CER is explored and the plausible impact on industry innovation is discussed.
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Affiliation(s)
- Yanni Hao
- Global Market Access & Commercial Strategy Operations, Janssen Global Services, Raritan, 700 US Highway 202 South, Room 1041, Raritan, NJ 08869, USA.
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Thompson JP, Abdolahi A, Noyes K. Modelling the cost effectiveness of disease-modifying treatments for multiple sclerosis: issues to consider. PHARMACOECONOMICS 2013; 31:455-69. [PMID: 23640103 PMCID: PMC3697004 DOI: 10.1007/s40273-013-0063-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Several cost-effectiveness models of disease-modifying treatments (DMTs) for multiple sclerosis (MS) have been developed for different populations and different countries. Vast differences in the approaches and discrepancies in the results give rise to heated discussions and limit the use of these models. Our main objective is to discuss the methodological challenges in modelling the cost effectiveness of treatments for MS. We conducted a review of published models to describe the approaches taken to date, to identify the key parameters that influence the cost effectiveness of DMTs, and to point out major areas of weakness and uncertainty. Thirty-six published models and analyses were identified. The greatest source of uncertainty is the absence of head-to-head randomized clinical trials. Modellers have used various techniques to compensate, including utilizing extension trials. The use of large observational cohorts in recent studies aids in identifying population-based, 'real-world' treatment effects. Major drivers of results include the time horizon modelled and DMT acquisition costs. Model endpoints must target either policy makers (using cost-utility analysis) or clinicians (conducting cost-effectiveness analyses). Lastly, the cost effectiveness of DMTs outside North America and Europe is currently unknown, with the lack of country-specific data as the major limiting factor. We suggest that limited data should not preclude analyses, as models may be built and updated in the future as data become available. Disclosure of modelling methods and assumptions could improve the transferability and applicability of models designed to reflect different healthcare systems.
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Affiliation(s)
- Joel P Thompson
- Department of Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642, USA.
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Carlson JJ, Thariani R, Roth J, Gralow J, Henry NL, Esmail L, Deverka P, Ramsey SD, Baker L, Veenstra DL. Value-of-information analysis within a stakeholder-driven research prioritization process in a US setting: an application in cancer genomics. Med Decis Making 2013; 33:463-71. [PMID: 23635833 PMCID: PMC3933300 DOI: 10.1177/0272989x13484388] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the feasibility and outcomes of incorporating value-of-information (VOI) analysis into a stakeholder-driven research prioritization process in a US-based setting. METHODS . Within a program to prioritize comparative effectiveness research areas in cancer genomics, over a period of 7 months, we developed decision-analytic models and calculated upper-bound VOI estimates for 3 previously selected genomic tests. Thirteen stakeholders representing patient advocates, payers, test developers, regulators, policy makers, and community-based oncologists ranked the tests before and after receiving VOI results. The stakeholders were surveyed about the usefulness and impact of the VOI findings. RESULTS The estimated upper-bound VOI ranged from $33 million to $2.8 billion for the 3 research areas. Seven stakeholders indicated the results modified their rankings, 9 stated VOI data were useful, and all indicated they would support its use in future prioritization processes. Some stakeholders indicated expected value of sampled information might be the preferred choice when evaluating specific STUDY DESIGN Limitations. Our study was limited by the size and the potential for selection bias in the composition of the external stakeholder group, lack of a randomized design to assess effect of VOI data on rankings, and the use of expected value of perfect information v. expected value of sample information methods. CONCLUSIONS Value of information analyses may have a meaningful role in research topic prioritization for comparative effectiveness research in the United States, particularly when large differences in VOI across topic areas are identified. Additional research is needed to facilitate the use of more complex value of information analyses in this setting.
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Affiliation(s)
| | | | - Josh Roth
- University of Washington, Seattle, WA, USA
| | | | - N. Lynn Henry
- SWOG and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Laura Esmail
- Center for Medical Technology Policy, Baltimore, MD, USA
| | - Pat Deverka
- Center for Medical Technology Policy, Baltimore, MD, USA
| | - Scott D. Ramsey
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - Laurence Baker
- SWOG and University of Michigan Medical School, Ann Arbor, MI, USA
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Basu A. Patient-centered or 'central' patient: Raising the veil of ignorance over randomization. Stat Med 2013; 31:3057-9; discussion 3066-7. [PMID: 23055182 DOI: 10.1002/sim.5398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Anirban Basu
- Department of Health Services & Pharmaceutical Outcomes Research and Policy Program, University of Washington Seattle, WA, U.S.A.
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Gaultney JG, Uyl-de Groot CA. Efficient allocation of novel agents in multiple myeloma: a work in progress. Oncologist 2013; 18:5-7. [PMID: 23299778 DOI: 10.1634/theoncologist.2012-0484] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Jennifer G Gaultney
- Institute for Medical Technology Assessment, Erasmus University, P.O. Box 1738, S000DR Rotterdam, The Netherlands.
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9
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Jay CL, Skaro AI. Comparative effectiveness research in liver transplantation: crossing the cost and quality chasm. J Comp Eff Res 2013; 2:7-9. [DOI: 10.2217/cer.12.65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Colleen L Jay
- Comprehensive Transplant Center, Northwestern University, Feinberg School of Medicine, 676 St Clair Street, Suite 19-087, Chicago, IL 60611, USA
- Department of Surgery, Division of Transplantation Surgery, Mayo Clinic, Rochester, MN, USA
| | - Anton I Skaro
- Comprehensive Transplant Center, Northwestern University, Feinberg School of Medicine, 676 St Clair Street, Suite 19-087, Chicago, IL 60611, USA
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Wong W, Ramsey SD, Barlow WE, Garrison LP, Veenstra DL. The value of comparative effectiveness research: projected return on investment of the RxPONDER trial (SWOG S1007). Contemp Clin Trials 2012; 33:1117-23. [PMID: 22981891 PMCID: PMC3486702 DOI: 10.1016/j.cct.2012.08.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 08/09/2012] [Accepted: 08/10/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The objective of this study was to assess the value of research of the RxPONDER study, an ongoing comparative effectiveness RCT designed to evaluate a 21-gene profile in early stage, node-positive breast cancer. METHODS We developed a disease-based decision-analytic model to compare use of the 21-gene profile versus standard care. Key clinical data were derived from SWOG-8814, an RCT of chemotherapy in lymph node-positive breast cancer. Other model parameters were obtained from published sources. Probabilistic simulations and value of information calculations were used to assess the expected value of sample information (EVSI) and the expected value of sample parameter information (EVSPI). RESULTS The cost of the RxPONDER trial is expected to be at least $27 million. The expected value of research of the RxPONDER trial ranged from $450 million to $1 billion, representing a return of 17 to 39 times the projected cost of the trial. The primary objective of RxPONDER, to assess survival, had the largest estimated value relative to other model inputs. The value of RxPONDER increased by $50 million to $100 million after stakeholder input on additional data collection. CONCLUSION The RxPONDER study appears to represent a good investment of public research funds. Stakeholder engagement and assessment of the return on investment should be considered to optimize and quantify the value of comparative effectiveness studies.
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Affiliation(s)
- William Wong
- Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA
| | - Scott D. Ramsey
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - William E. Barlow
- SWOG Statistical Center (Cancer Research and Biostatistics), Seattle, WA
| | - Louis P. Garrison
- Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA
| | - David L. Veenstra
- Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA
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Basu A, Meltzer D. Private manufacturers' thresholds to invest in comparative effectiveness trials. PHARMACOECONOMICS 2012; 30:859-868. [PMID: 22901018 PMCID: PMC4309827 DOI: 10.2165/11597730-000000000-00000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The recent rush of enthusiasm for public investment in comparative effectiveness research (CER) in the US has focussed attention on these public investments. However, little attention has been given to how changing public investment in CER may affect private manufacturers' incentives for CER, which has long been a major source of CER. In this work, based on a simple revenue maximizing economic framework, we generate predictions on thresholds to invest in CER for a private manufacturer that compares its own product to a competitor's product in head-to-head trials. Our analysis shows that private incentives to invest in CER are determined by how the results of CER may affect the price and quantity of the product sold and the duration over which resulting changes in revenue would accrue, given the time required to complete CER and the time from the completion of CER to the time of patent expiration. We highlight the result that private incentives may often be less than public incentives to invest in CER and may even be negative if the likelihood of adverse findings is sufficient. We find that these incentives imply a number of predictions about patterns of CER and how they will be affected by changes in public financing of CER and CER methods. For example, these incentives imply that incumbent patent holders may be less likely to invest in CER than entrants and that public investments in CER may crowd out similar private investments. In contrast, newer designs and methods for CER, such as Bayesian adaptive trials, which can reduce ex post risk of unfavourable results and shorten the time for the production of CER, may increase the expected benefits of CER and may tend to increase private investment in CER as long as the costs of such innovative designs are not excessive. Bayesian approaches to design also naturally highlight the dynamic aspects of CER, allowing less expensive initial studies to guide decisions about future investments and thereby encouraging greater initial investments in CER. However, whether the potential effects we highlight of public funding of CER and of Bayesian approaches to trial design actually produce changes in private investment in CER remains an empirical question.
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Affiliation(s)
- Anirban Basu
- Department of Health Services and Pharmaceutical Outcomes Research and Policy Program (PORPP), University of Washington, Seattle, WA 98195-7660, USA.
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Powers BJ, Coeytaux RR, Dolor RJ, Hasselblad V, Patel UD, Yancy WS, Gray RN, Irvine RJ, Kendrick AS, Sanders GD. Updated report on comparative effectiveness of ACE inhibitors, ARBs, and direct renin inhibitors for patients with essential hypertension: much more data, little new information. J Gen Intern Med 2012; 27:716-29. [PMID: 22147122 PMCID: PMC3358398 DOI: 10.1007/s11606-011-1938-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Revised: 09/13/2010] [Accepted: 10/26/2011] [Indexed: 02/07/2023]
Abstract
OBJECTIVES A 2007 systematic review compared angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) in patients with hypertension. Direct renin inhibitors (DRIs) have since been introduced, and significant new research has been published. We sought to update and expand the 2007 review. DATA SOURCES We searched MEDLINE and EMBASE (through December 2010) and selected other sources for relevant English-language trials. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS We included studies that directly compared ACE inhibitors, ARBs, and/or DRIs in at least 20 total adults with essential hypertension; had at least 12 weeks of follow-up; and reported at least one outcome of interest. Ninety-seven (97) studies (36 new since 2007) directly comparing ACE inhibitors versus ARBs and three studies directly comparing DRIs to ACE inhibitor inhibitors or ARBs were included. STUDY APPRAISAL AND SYNTHESIS METHODS A standard protocol was used to extract data on study design, interventions, population characteristics, and outcomes; evaluate study quality; and summarize the evidence. RESULTS In spite of substantial new evidence, none of the conclusions from the 2007 review changed. The level of evidence remains high for equivalence between ACE inhibitors and ARBs for blood pressure lowering and use as single antihypertensive agents, as well as for superiority of ARBs for short-term adverse events (primarily cough). However, the new evidence was insufficient on long-term cardiovascular outcomes, quality of life, progression of renal disease, medication adherence or persistence, rates of angioedema, and differences in key patient subgroups. LIMITATIONS Included studies were limited by follow-up duration, protocol heterogeneity, and infrequent reporting on patient subgroups. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Evidence does not support a meaningful difference between ACE inhibitors and ARBs for any outcome except medication side effects. Few, if any, of the questions that were not answered in the 2007 report have been addressed by the 36 new studies. Future research in this area should consider areas of uncertainty and be prioritized accordingly.
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Jagsi R, Bekelman JE, Brawley OW, Deasy JO, Le QT, Michalski JM, Movsas B, Thomas CR, Lawton CA, Lawrence TS, Hahn SM. A research agenda for radiation oncology: results of the radiation oncology institute's comprehensive research needs assessment. Int J Radiat Oncol Biol Phys 2012; 84:318-22. [PMID: 22436790 DOI: 10.1016/j.ijrobp.2011.11.076] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 11/22/2011] [Accepted: 11/22/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE To promote the rational use of scarce research funding, scholars have developed methods for the systematic identification and prioritization of health research needs. The Radiation Oncology Institute commissioned an independent, comprehensive assessment of research needs for the advancement of radiation oncology care. METHODS AND MATERIALS The research needs assessment used a mixed-method, qualitative and quantitative social scientific approach, including structured interviews with diverse stakeholders, focus groups, surveys of American Society for Radiation Oncology (ASTRO) members, and a prioritization exercise using a modified Delphi technique. RESULTS Six co-equal priorities were identified: (1) Identify and develop communication strategies to help patients and others better understand radiation therapy; (2) Establish a set of quality indicators for major radiation oncology procedures and evaluate their use in radiation oncology delivery; (3) Identify best practices for the management of radiation toxicity and issues in cancer survivorship; (4) Conduct comparative effectiveness studies related to radiation therapy that consider clinical benefit, toxicity (including quality of life), and other outcomes; (5) Assess the value of radiation therapy; and (6) Develop a radiation oncology registry. CONCLUSIONS To our knowledge, this prioritization exercise is the only comprehensive and methodologically rigorous assessment of research needs in the field of radiation oncology. Broad dissemination of these findings is critical to maximally leverage the impact of this work, particularly because grant funding decisions are often made by committees on which highly specialized disciplines such as radiation oncology are not well represented.
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Affiliation(s)
- Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, USA.
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Pickard AS, Lee TA, Solem CT, Joo MJ, Schumock GT, Krishnan JA. Prioritizing comparative-effectiveness research topics via stakeholder involvement: an application in COPD. Clin Pharmacol Ther 2011; 90:888-92. [PMID: 22048220 DOI: 10.1038/clpt.2011.237] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A major priority for funding agencies and researchers involved in comparative-effectiveness research (CER) is to ensure that research questions will produce findings that are relevant and feasible to implement. In this article, we describe a process for involving experts and stakeholders in identifying and prioritizing CER studies, as illustrated by our experience in chronic obstructive pulmonary disease (COPD).
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Affiliation(s)
- A S Pickard
- Center for Pharmacoeconomic Research and Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA.
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Basu A. Economics of individualization in comparative effectiveness research and a basis for a patient-centered health care. JOURNAL OF HEALTH ECONOMICS 2011; 30:549-59. [PMID: 21601299 PMCID: PMC3110511 DOI: 10.1016/j.jhealeco.2011.03.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 03/16/2011] [Accepted: 03/31/2011] [Indexed: 05/04/2023]
Abstract
The United States aspires to use information from comparative effectiveness research (CER) to reduce waste and contain costs without instituting a formal rationing mechanism or compromising patient or physician autonomy with regard to treatment choices. With such ambitious goals, traditional combinations of research designs and analytical methods used in CER may lead to disappointing results. In this paper, I study how alternate regimes of comparative effectiveness information help shape the marginal benefits (demand) curve in the population and how such perceived demand curves impact decision-making at the individual patient level and welfare at the societal level. I highlight the need to individualize comparative effectiveness research in order to generate the true (normative) demand curve for treatments. I discuss methodological principles that guide research designs for such studies. Using an example of the comparative effect of substance abuse treatments on crime, I use novel econometric methods to salvage individualized information from an existing dataset.
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Affiliation(s)
- Anirban Basu
- Department of Health Services, University of Washington, Seattle, 1959 NE Pacific St, Box 357660, Seattle, WA 98195-7660, USA.
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Implications of comparative effectiveness research for radiation oncology. Pract Radiat Oncol 2011; 1:72-80. [PMID: 24673918 DOI: 10.1016/j.prro.2011.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Accepted: 02/13/2011] [Indexed: 11/23/2022]
Abstract
PURPOSE The essence of comparative effectiveness research (CER) is to understand what health interventions work, for which patients, and under what conditions. The objective of this article is to introduce the relative strengths and weaknesses of several forms of evidence to illustrate the potential for CER evidence generation within radiation oncology. METHODS We introduce the underlying concepts of effectiveness and efficacy. We describe the design of traditional explanatory randomized trials (RCTs). We introduce the rationale, strengths, and weaknesses of several alternative study designs for comparative effectiveness, including pragmatic clinical trials, adaptive trials, and observational (nonrandomized) studies. RESULTS Explanatory RCTs are designed to assess the efficacy of an intervention while achieving a high degree of internal validity. Pragmatic clinical trials (PCTs) are prospective studies performed in typical, real-world clinical practice settings. The emphasis of PCTs is to maintain a degree of internal validity while also maximizing external validity. Adaptive trials can be modified at interim stages using existing or evolving evidence in the course of a trial, which may allow trials to maintain clinical relevance by studying current treatments. Observational data are becoming increasingly important, given substantial funding for clinical registries and greater availability of electronic medical records and claims databases, but need to address well-known limitations such as selection bias. CONCLUSION With the rapid proliferation of new and evolving radiotherapy technologies, it is incumbent upon our field to invest in building the evidence base for radiotherapy CER and to actively participate in current initiatives for generating comparative evidence.
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Abstract
For personalized medicine to be widely adopted in clinical practice, stakeholders need evidence of effectiveness, cost effectiveness and financial viability. Comparative effectiveness research (CER) using population based, retrospective data can inform assessments of personalized medicine. The purpose of this paper is to explore the potential and the limitations of CER. While the analytic methods and data used for CER overcome many of the disadvantages of randomized controlled trials, there are significant barriers, including lack of routinely collected genetic information, patient-reported outcomes and information on new and emerging technologies. Recommendations for using CER include augmenting current data with genetic information, promoting the collection of uniform health outcomes, using value of information analysis to guide development of new technologies, and greater use of decision analysis. Finally, in order to address stakeholder concerns regarding short term financial viability, additional emphasis should be devoted to cost analysis of implementation costs and overall financial impact.
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Nellesen D, Birnbaum HG, Greenberg PE. Perspectives on comparative effectiveness research: views from diverse constituencies. PHARMACOECONOMICS 2010; 28:789-798. [PMID: 20831287 DOI: 10.2165/11535790-000000000-00000] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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