"CER assists all healthcare stakeholders in healthcare in making informed decisions to improve outcomes at the individual and population levels. The contrasting merits between randomized control trials (RCTs), the gold standard in CER, and observational studies have recently been highlighted as they pertain to specific challenges in oncology such as rising costs and rapidly evolving technology  . The challenges of performing RCTs, even when there is a good clinical question, have been clearly illustrated in lung SABR. "
"posttraumatic stress disorder (PTSD), because dropout is unlikely to occur at random, inferences drawn from these data may not be valid without statistical adjustment; however, such adjustments may not be feasible. For example, the use of inverse probability weighting requires that the weights appropriately model the true pattern of dropout , which is difficult to do without knowing the reasons for dropout. Patients may drop out for several reasons, including early improvement , failure to improve, or other reasons . "
[Show abstract][Hide abstract] ABSTRACT: A large body of comparative effectiveness research (CER) focuses on the use of observational and quasi-experimental approaches. We sought to examine the use of clinical trials as a tool for CER, particularly in mental health.
Examination of three ongoing randomized clinical trials in psychiatry addressing issues that would pose difficulties for nonexperimental CER methods.
Existing statistical approaches to nonexperimental data appear insufficient to compensate for biases that may arise when the pattern of missing data cannot be properly modeled such as when there are no standards for treatment, when affected populations have limited access to treatment, or when there are high rates of treatment dropout.
Clinical trials should retain an important role in CER, particularly in cases of high disorder prevalence, large expected effect sizes, difficult-to-reach populations, or when examining sequential treatments or stepped-care algorithms. Progress in CER on mental health will require careful consideration of appropriate selection between clinical trials and nonexperimental designs and on allocation of research resources to optimally inform key treatment decisions for each patient.
[Show abstract][Hide abstract] ABSTRACT: Comparative effectiveness research (CER) has captured the attention of the biomedical community, including physicians, other health care professionals, and clinical researchers; the public, including patients and their advocates; and policy makers, including funding agencies and health care insurers. This keen interest is based, at least in part, on the hope that the findings from CER will provide useful information to help clinicians make evidence-based decisions, will incorporate patient preferences and patient-centered perspectives, and, ultimately, will improve the quality of care and help control health care costs.
JAMA The Journal of the American Medical Association 04/2012; 307(15):1643-5. DOI:10.1001/jama.2012.490 · 30.39 Impact Factor
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