PharmacoEconomics & Outcomes News 665 - 27 Oct 2012

Comparative effectivenessresearch – lost in translation?

There are five main reasons why many comparativeeffectiveness research studies have failed to translateinto changes in clinical practice in the US, according toresearch published in HealthAffairs.

The researchers, led by Justin Timbie from the RANDCorporation, reviewed selected comparativeeffectiveness studies from the past 10 years andexamined the events that followed. From this theyidentified the main causes as to why such studies havenot altered treatment practice:• misalignment of financial incentives, such as fee-

for-service payments and plentiful insurancepayments that push patients and providers to usetreatments that are no more effective thanconservative treatments

• ambiguity of results where studies produce datathat are often inconclusive

• cognitive biases in interpreting new data,including confirmation bias (tendency to acceptedevidence confirming preconceived ideas andrejecting contradictory evidence), pro-interventionbias (tendency to favour treatment over notreatment, even if the benefit is not clinicallymeaningful), and pro-technology bias (tendency tothink that new technology is better than oldtechnology)

• needs of end users not addressed and clinicians,patients and policy makers may want different thingsfrom the research

• use of decision support limited with only a fewhealthcare systems such as the Department ofVeterans Affairs having decision support tools inuse.

Timbie and colleagues then proposed three policyoptions to improve the future success of integratingcomparative efffectiveness research findings intoroutine practice. Firstly, they suggest that the objectivesand design of the study use a concensus developmentprocess to guide result interpretation. Secondly,multidisciplinary and balanced groups should be used todevelop treatment guidelines, such as those proposedby the Institute of Medicine in 2011. Finally, newpayment and coverage policies (such as global orbundled payments) should encourage delivery ofefficient care.

The researchers say that the "policies we recommendmay provide the greatest leverage to speed thetranslation of evidence into practice".Timbie JW, et al. Five Reasons That Many Comparative Effectiveness Studies FailTo Change Patient Care And Clinical Practice. Health Affairs 31: 2168-2175, No.10, 19 Oct 2012. Available from: URL: http://dx.doi.org/10.1377/hlthaff.2012.0150 803079055

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PharmacoEconomics & Outcomes News 27 Oct 2012 No. 6651173-5503/10/0665-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved