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Tambor E, Robinson M, Hsu L, Chang HY, Al Naber J. coreSCD: multi-stakeholder consensus on core outcomes for sickle cell disease clinical trials. BMC Med Res Methodol 2021; 21:219. [PMID: 34666680 PMCID: PMC8524872 DOI: 10.1186/s12874-021-01413-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/24/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND With the dramatic increase in the pipeline for new sickle cell disease (SCD) therapies in recent years, the time is ripe to ensure a robust body of evidence is available for decision making by regulators, payers, clinicians, and patients. Harmonization of the outcomes selected across interventional trials enables optimal post-trial appraisal and decision making through valid pooled analyses and indirect comparisons. We employed a structured, multi-stakeholder consensus process to develop core outcome sets (COS) for use in clinical trials of SCD interventions. METHODS CoreSCD utilized a modified Delphi method adapted from the standards recommended by the Core Outcome Measures in Effectiveness Trials (COMET) Initiative. An initial list of candidate outcomes was developed through a targeted literature review and input from an 11-member advisory committee. A 44-member multi-stakeholder Delphi Panel was established and included patients and family members, advocates, clinicians, researchers, payers, health technology assessors, representatives from government agencies, and industry representatives. Patients/advocates comprised 25% of the Delphi Panel and orientation and training was provided prior to the consensus process to ensure all were prepared to participate meaningfully. Panelists completed three rounds of an online survey to rate the importance of candidate outcomes for inclusion in the COS. Summary data was provided between each voting round and an in-person consensus meeting was held between the second and third round of voting. Consensus rules were applied following each round of voting to eliminate outcomes that did not meet predetermined criteria for retention. RESULTS Consensus was reached for two core outcome sets. The final COS for trials of disease-modifying therapies includes ten outcomes and the COS for trials of acute interventions includes six outcomes. Both core sets include clinical outcomes as well as outcomes related to functioning/quality of life, resource utilization, and survival/mortality. CONCLUSIONS Use of the COS in clinical development programs for SCD will help to ensure that relevant, consistent outcomes are available for decision making across the product lifecycle.
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Affiliation(s)
- Ellen Tambor
- Center for Medical Technology Policy, 401 E. Pratt St., Suite 631, Baltimore, MD, 21202, USA.
| | | | - Lewis Hsu
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA
| | - Hsing-Yuan Chang
- Center for Medical Technology Policy, 401 E. Pratt St., Suite 631, Baltimore, MD, 21202, USA
| | - Jennifer Al Naber
- Center for Medical Technology Policy, 401 E. Pratt St., Suite 631, Baltimore, MD, 21202, USA
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Clearfield E, Miller V, Nadglowski J, Barradas K, Al Naber J, Sanyal AJ, Neuschwander-Tetri BA, Messner DA. coreNASH: Multi-stakeholder Consensus on Core Outcomes for Decision Making About Nonalcoholic Steatohepatitis Treatment. Hepatol Commun 2021; 5:774-785. [PMID: 34027268 PMCID: PMC8122373 DOI: 10.1002/hep4.1678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/06/2020] [Accepted: 12/26/2020] [Indexed: 12/14/2022] Open
Abstract
The increasing prevalence and burden of nonalcoholic steatohepatitis (NASH) has spurred the development of new treatments and a need to consider outcomes used for NASH treatment decision making. Development of a NASH core outcome set (COS) can help prioritize outcomes of highest importance by incorporating the perspectives from a variety of decision makers. coreNASH was an initiative to develop a COS for NASH using a modified Delphi consensus process with a multi-stakeholder voting panel. A candidate outcome list was created based on a literature review and key informant interviews. The candidate outcome list was then condensed and prioritized through three rounds of online voting and through discussion at an in-person meeting. Outcomes were retained or eliminated based on predetermined consensus criteria, which included special weighting of patients' opinions in the first two voting rounds. The coreNASH Delphi panel included 53 participants (7 patients, 10 clinicians and researchers, 7 health technology assessors, 22 industry representatives, 2 regulators, and 5 payers) who considered outcomes for two NASH-related COS: one for NASH without cirrhosis (F2-F3) and one for NASH with cirrhosis (F4). The initial candidate outcome list for both disease stages included 86 outcomes. The panel agreed on including two core outcomes for NASH without cirrhosis and nine core outcomes for NASH with cirrhosis in the COS. Conclusion: A consensus-based COS has been developed that can be used across the life cycle of NASH treatments. Outcomes included can contribute to decision making for regulatory, market access, and on-market decision making. Including the coreNASH COS in clinical development programs will facilitate improved comparisons and help decision makers assess the value of new products.
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Tejwani V, Chang HY, Tran AP, Naber JA, Gutzwiller FS, Winders TA, Khurana S, Sumino K, Mosnaim G, Moloney RM. A multistakeholder Delphi consensus core outcome set for clinical trials in moderate-to-severe asthma (coreASTHMA). Ann Allergy Asthma Immunol 2021; 127:116-122.e7. [PMID: 33781936 DOI: 10.1016/j.anai.2021.03.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/09/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Treatments for long-term control of asthma have improved and include a promising but expensive class of biologic therapies. However, the clinical trials evaluating these and other novel treatments have used a variety of different outcomes to evaluate efficacy. The evolution of asthma care calls for a re-examination of outcomes that are most important to patients and other stakeholders. OBJECTIVE To develop a core set of outcomes to be measured in phase 3 and phase 4 clinical drug trials in patients with moderate-to-severe asthma. METHODS We used a robust and in-depth multistakeholder consensus process bringing together patients, clinicians, regulators, payers, health technology assessors, researchers, and product developers to reach consensus on outcomes. We used a modified Delphi method to reach consensus, an approach adapted from the Core Outcome Measures in Effectiveness Trials Initiative aligned with contemporary methodological standards for core outcome set development. RESULTS The following outcomes were included in the final core set: severe asthma exacerbation, change in asthma control, asthma-specific or severe asthma-specific quality of life, asthma-specific hospital stay (ie, >24-hour stays at any level of care) or admission, and asthma-specific emergency department visit. CONCLUSION These 5 outcomes represent a minimum set of core outcomes for use in phase 3 and phase 4 clinical drug trials in moderate-to-severe asthma. Consistent collection of these outcomes as minimum, independent of whether additional heterogeneous primary or secondary outcomes are included, will allow for meaningful comparisons of the effect of asthma therapies across clinical trials.
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Affiliation(s)
- Vickram Tejwani
- Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland.
| | | | - Annie P Tran
- Center for Medical Technology Policy, Baltimore, Maryland
| | | | | | | | - Sandhya Khurana
- Pulmonary and Critical Care Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Kaharu Sumino
- Pulmonary and Critical Care Medicine, Washington University, St. Louis, Missouri
| | - Giselle Mosnaim
- Pulmonary, Allergy and Critical Care, NorthShore University HealthSystem, Evanston, Illinois
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Tran AP, Al Naber J, Myers ER. Authors' response to letter to the editor: the role of core outcomes in shared decision-making for uterine fibroid treatment. Am J Obstet Gynecol 2021; 224:331. [PMID: 33212040 DOI: 10.1016/j.ajog.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/10/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Annie P Tran
- Center for Medical Technology Policy, 401 East Pratt St., Ste. 631, Baltimore, MD 21202.
| | - Jennifer Al Naber
- Center for Medical Technology Policy, 401 East Pratt St., Ste. 631, Baltimore, MD 21202
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Tejwani V, Chang HY, Tran A, Al Naber J, Moloney R. CORE OUTCOME SET FOR PHASE 3 AND 4 INTERVENTIONAL TRIALS IN MODERATE TO SEVERE ASTHMA. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Tran AP, Al Naber J, Tambor ES, Myers ER. Addressing heterogenous outcomes in uterine fibroid research: a call to action. Am J Obstet Gynecol 2020; 223:75.e1-75.e5. [PMID: 32199924 DOI: 10.1016/j.ajog.2020.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/27/2020] [Accepted: 03/12/2020] [Indexed: 01/20/2023]
Abstract
Uterine fibroid tumors are the most common benign pelvic tumors in women, with complications that include heavy menstrual bleeding, pelvic pain, reproductive complications, and bulk-related symptoms. Although the majority of uterine fibroid tumors are asymptomatic, those women who experience symptoms can experience substantial burdens on quality of life and daily functioning. Comparative effectiveness reviews of available medical, surgical, and radiologic treatments have found that a lack of high-quality data to inform treatment decisions is, in part, due to the use of heterogeneous outcomes and instruments in clinical studies. With multiple new interventions emerging, this call-to-action encourages the development and use of a core outcome set that will capture the most relevant, patient-important outcomes in late-phase and after-marketing therapeutic trials for uterine fibroid tumors. The core outcome set should be developed by a diverse, multistakeholder group comprised of key healthcare decision-makers. Development and uptake of a core outcome set ensures that a consistent, collaboratively vetted set of outcomes will be accessible across different studies and promotes transparency for innovators who seek to anticipate the evidence needs of patients, providers, payers, regulators, and other stakeholders.
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Affiliation(s)
- Annie P Tran
- Center for Medical Technology Policy, Baltimore, MD
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Tambor E, Shalowitz M, Harrington JM, Hull K, Watson N, Sital S, Al Naber J, Miller D. Engaging patients, clinicians, and the community in a Clinical Data Research Network: Lessons learned from the CAPriCORN CDRN. Learn Health Syst 2019; 3:e10079. [PMID: 31245603 PMCID: PMC6508783 DOI: 10.1002/lrh2.10079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/08/2018] [Accepted: 12/07/2018] [Indexed: 11/29/2022] Open
Abstract
Engaging patients, clinicians, and community members in the development of a research network creates opportunities and challenges beyond engagement in discrete learning activities. This paper describes our experiences establishing and maintaining a stakeholder engagement infrastructure for the Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) and highlights important lessons learned over the first 4 years. During this time, the CAPriCORN Patient and Community Advisory Committee (PCAC) appointed patient, clinician, and community representatives to governance and advisory groups throughout the network, developed a process and criteria for patient- and clinician-centered review of research proposals, and evolved from a large, diverse group to a smaller yet still diverse, more actively engaged group with connections to the broader community. Key challenges faced by the PCAC have included determining the optimal size and composition of the group, understanding the complex structure of the network as a whole, coordinating with other network entities and functions, and integrating the patient and community voice into the research review process. Efforts to engage stakeholders in clinical data research networks should anticipate and develop solutions to address these challenges.
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Affiliation(s)
- Ellen Tambor
- Center for Medical Technology PolicyBaltimoreMDUSA
| | | | | | - Kevin Hull
- West Side Institute for Science and Education, at the Jesse Brown VA Medical CenterChicagoILUSA
| | - Natalie Watson
- Center for Community Health and VitalityUniversity of Chicago MedicineChicagoILUSA
| | - Shelly Sital
- Chicago Area Patient‐Centered Outcomes Research Network (CAPriCORN)ChicagoILUSA
| | | | - Doriane Miller
- Center for Community Health and VitalityUniversity of Chicago MedicineChicagoILUSA
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Conley RB, Dickson D, Zenklusen JC, Al Naber J, Messner DA, Atasoy A, Chaihorsky L, Collyar D, Compton C, Ferguson M, Khozin S, Klein RD, Kotte S, Kurzrock R, Lin CJ, Liu F, Marino I, McDonough R, McNeal A, Miller V, Schilsky RL, Wang LI. Core Clinical Data Elements for Cancer Genomic Repositories: A Multi-stakeholder Consensus. Cell 2017; 171:982-986. [PMID: 29149611 DOI: 10.1016/j.cell.2017.10.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Center for Medical Technology Policy and the Molecular Evidence Development Consortium gathered a diverse group of more than 50 stakeholders to develop consensus on a core set of data elements and values essential to understanding the clinical utility of molecularly targeted therapies in oncology.
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Affiliation(s)
- Robert B Conley
- Center for Medical Technology Policy, Baltimore, MD 21202, USA
| | - Dane Dickson
- Molecular Evidence Development Consortium, Rexburg, ID 83440, USA.
| | | | | | - Donna A Messner
- Center for Medical Technology Policy, Baltimore, MD 21202, USA
| | - Ajlan Atasoy
- European Organisation for Research and Treatment of Cancer, 1200 Brussels, Belgium
| | | | | | - Carolyn Compton
- Arizona State University, Mayo Clinic, Phoenix, AZ 85257, USA
| | | | - Sean Khozin
- Food and Drug Administration, Silver Spring, MD 20993, USA
| | | | | | - Razelle Kurzrock
- Moores Cancer Center, University of California, San Diego, La Jolla, CA 92093, USA
| | | | - Frank Liu
- Merck Sharp & Dohme, North Wales, PA 19454, USA
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Messner DA, Koay P, Al Naber J, Cook-Deegan R, Majumder M, Javitt G, Dvoskin R, Bollinger J, Curnutte M, McGuire AL. Barriers to clinical adoption of next-generation sequencing: a policy Delphi panel's solutions. Per Med 2017; 14:339-354. [PMID: 29230253 DOI: 10.2217/pme-2016-0104] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Aim Identify solutions to the most important policy barriers to the clinical adoption of next-generation sequencing. Materials & methods Four-round modified policy Delphi with a multistakeholder panel of 48 experts. The panel deliberated policy solutions to (previously reported) challenges deemed most important to address. Results The group advocated using consensus panels to promote consistency in payer policies and to standardize test reporting, and favored making genomic data-sharing a condition of regulatory clearance, certification, or accreditation processes. They were split on the role of US FDA. Conclusion Panelists found common ground on solutions for health plan coverage policy consistency, data-sharing, and standardizing reporting, but were sharply divided on the role of the FDA in mitigating risks to patients.
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Affiliation(s)
- Donna A Messner
- Center for Medical Technology Policy, Baltimore, MD 21202, USA
| | - Pei Koay
- Center for Medical Technology Policy, Baltimore, MD 21202, USA
| | | | - Robert Cook-Deegan
- School for the Future of Innovation in Society, and Consortium for Science, Policy & Outcomes, Arizona State University, Tempe, AZ 85281, USA
| | - Mary Majumder
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX 77030, USA
| | - Gail Javitt
- Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Rachel Dvoskin
- Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Juli Bollinger
- Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Margaret Curnutte
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX 77030, USA
| | - Amy L McGuire
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX 77030, USA
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Messner DA, Al Naber J, Koay P, Cook-Deegan R, Majumder M, Javitt G, Deverka P, Dvoskin R, Bollinger J, Curnutte M, Chandrasekharan S, McGuire A. Barriers to clinical adoption of next generation sequencing: Perspectives of a policy Delphi panel. Appl Transl Genom 2016; 10:19-24. [PMID: 27668172 PMCID: PMC5025465 DOI: 10.1016/j.atg.2016.05.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/10/2016] [Accepted: 05/23/2016] [Indexed: 04/23/2023]
Abstract
This research aims to inform policymakers by engaging expert stakeholders to identify, prioritize, and deliberate the most important and tractable policy barriers to the clinical adoption of next generation sequencing (NGS). A 4-round Delphi policy study was done with a multi-stakeholder panel of 48 experts. The first 2 rounds of online questionnaires (reported here) assessed the importance and tractability of 28 potential barriers to clinical adoption of NGS across 3 major policy domains: intellectual property, coverage and reimbursement, and FDA regulation. We found that: 1) proprietary variant databases are seen as a key challenge, and a potentially intractable one; 2) payer policies were seen as a frequent barrier, especially a perceived inconsistency in standards for coverage; 3) relative to other challenges considered, FDA regulation was not strongly perceived as a barrier to clinical use of NGS. Overall the results indicate a perceived need for policies to promote data-sharing, and a desire for consistent payer coverage policies that maintain reasonably high standards of evidence for clinical utility, limit testing to that needed for clinical care decisions, and yet also flexibly allow for clinician discretion to use genomic testing in uncertain circumstances of high medical need.
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Affiliation(s)
- Donna A. Messner
- Center for Medical Technology Policy, 401 East Pratt Street, Suite 631, Baltimore, MD 21207, USA
| | - Jennifer Al Naber
- Center for Medical Technology Policy, 401 East Pratt Street, Suite 631, Baltimore, MD 21207, USA
| | - Pei Koay
- Center for Medical Technology Policy, 401 East Pratt Street, Suite 631, Baltimore, MD 21207, USA
| | | | - Mary Majumder
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Gail Javitt
- Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Avenue, Baltimore, MD 21205, USA
| | - Patricia Deverka
- American Institutes for Research, 1000 Thomas Jefferson Street NW, Washington, DC 20007, USA
| | - Rachel Dvoskin
- Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Avenue, Baltimore, MD 21205, USA
| | - Juli Bollinger
- Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Avenue, Baltimore, MD 21205, USA
| | - Margaret Curnutte
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | | | - Amy McGuire
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
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