scholarly journals Tying comparative effectiveness information to decision-making and the future of comparative effectiveness research designs: the case for antipsychotic drugs

2012 ◽  
Vol 1 (2) ◽  
pp. 171-180 ◽  
Author(s):  
Anirban Basu ◽  
Herbert Y Meltzer
Keyword(s):  
Decision Making ◽  
Comparative Effectiveness Research ◽  
Comparative Effectiveness ◽  
Antipsychotic Drugs ◽  
Effectiveness Research ◽  
Research Designs ◽  
The Future

Personalized Medicine in the Context of Comparative Effectiveness Research

2013 ◽  
Vol 16 (2) ◽  
pp. S73-S86 ◽  
Author(s):  
Anirban Basu
Keyword(s):  
Decision Making ◽  
Personalized Medicine ◽  
Comparative Effectiveness Research ◽  
Comparative Effectiveness ◽  
Genomic Research ◽  
Future Research ◽  
Effectiveness Research ◽  
Medical Quality ◽  
Clinical Scenarios ◽  
Objective Evidence

Abstract The world of patient-centered outcomes research (PCOR) seems to bridge the previously disjointed worlds of comparative effectiveness research (CER) and personalized medicine (PM). Indeed, theoretical reasoning on how information on medical quality should inform decision making, both at the individual and the policy level, reveals that personalized information on the value of medical products is critical for improving decision making at all levels. However, challenges to generating, evaluating and translating evidence that might lead to personalization need to be critically assessed. In this paper, I discuss two different concepts of personalized medicine – passive personalization (PPM) and active personalization (APM) that are important to distinguish in order to invest efficiently in PCOR and develop objective evidence on the value of personalization that will aid in its translation. APM constitutes the process of actively seeking identifiers, which can be genotypical, phenotypical or even environmental, that can be used to differentiate between the marginal benefits of treatment across patients. In contrast, PPM involves a passive approach to personalization where, in the absence of explicit research to discover identifiers, patients and physicians “learn by doing” mostly due to the repeated use of similar products on similar patients. Benchmarking the current state of PPM sets the bar to which the expected value of any new APM agenda should be evaluated. Exploring processes that enable PPM in practice can help discover new APM agendas, such as those based on developing predictive algorithms based on clinical, phenotypical and preference data, which may be more efficient that trying to develop expensive genetic tests. It can also identify scenarios or subgroups of patients where genomic research would be most valuable since alternative prediction algorithms were difficult to develop in those settings. Two clinical scenarios are discussed where PPM was explored through novel econometric methods. Related discussions around exploring PPM processes, multi-dimensionality of outcomes, and a balanced agenda for future research on personalization follow.

Comparative effectiveness research: policy and politics

2012 ◽  
Vol 33 (1) ◽  
pp. E6 ◽  
Author(s):  
Edie E. Zusman
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Comparative Effectiveness Research ◽  
Comparative Effectiveness ◽  
Research Policy ◽  
Effectiveness Research ◽  
Care Providers ◽  
Future Health ◽  
The Future ◽  
Key Aspects

Comparative effectiveness research (CER) is the basis for some of the fiercest rhetoric of the current political era. While it is a relatively old and previously academic pursuit, CER may well become the foundation upon which the future of health care in the US is based. The actual impact of CER on—and uptake among—doctors, patients, hospitals, and health insurers, however, remains to be seen. Political considerations and compromises have led to the removal of key aspects of CER implementation from policy legislation to prevent alienating stakeholders critical to the success of health care reform. Health care providers, including specialists such as neurosurgeons, will need to understand both the policies and political implications of CER as its practices becomes an indelible part of the future health care landscape.

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