The Pragmatist's Guide to Comparative Effectiveness Research

Chandra, Amitabh; Jena, Anupam B.; Skinner, Jonathan

doi:10.3386/w16990

Cited by 14 publications

(14 citation statements)

References 15 publications

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“…41 Although this may be true, several recent studies demonstrate a significant impact of negative comparative effectiveness studies on clinical practice. 36,37,[42][43][44][45] These findings, in conjunction with ours, lend credence to the theory that new evidence that resolves ambiguity about the benefits of a treatment will reduce variation in its use. 45 In the case of the COURAGE trial, the study may have further benefited from widespread media attention both preceding and following announcement of the results, 46 reflecting the business risk faced by stent manufacturers, significant publicity by the American College of Cardiology before the meeting, as well as a significant gap between the volume of PCI for SIHD and evidence of its benefit.…”

Section: Discussionsupporting

confidence: 59%

Changes in Geographic Variation in the Use of Percutaneous Coronary Intervention for Stable Ischemic Heart Disease After Publication of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) Trial

Mohan

Fazel

Huang

et al. 2014

Circ: Cardiovascular Quality and Outcomes

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Background-Clinical uncertainty is cited as a cause of geographic variation. However, little is known about the effect of comparative effectiveness research on variation. We examined whether geographic variation in the use of percutaneous coronary intervention (PCI) for stable ischemic heart disease (SIHD) declined after publication of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial. Methods and Results-We examined changes in utilization and geographic variation in 67 hospital referral regions using the State Inpatient Databases. We compared age-and sex-adjusted rates of PCI for SIHD before (2006) and after (2008) publication of the COURAGE trial and compared those with contemporaneous changes in PCI volume for acute coronary syndrome. A total of 272 659 PCIs for SIHD from 526 hospitals were included in the analysis. After the publication of the COURAGE trial, PCI volume for SIHD declined by 25% (P<0.001) and decreased by 12% for acute coronary syndrome (P<0.001). This was predominantly attributable to changes in hospital referral regions with the highest levels of utilization pre-COURAGE trial (35% decline in the highest tertile versus 18% in the lowest). As measured by the systematic component of variation, there was substantial geographic variation in the use of PCI for SIHD preceding the publication of the COURAGE trial. Variation declined by 28% (0.53 versus 0.40) after publication, but geographic variation remained higher for SIHD than acute coronary syndrome (0.40 versus 0.17). Conclusions-There was a substantial decline in the use of and geographic variation in PCI for SIHD after the publication of the COURAGE trial. However, geographic variation in the use of PCI for SIHD remained high. (Circ Cardiovasc Qual Outcomes. 2014;7:125-130.)Key Words: coronary artery disease ◼ health policy ◼ outcome assessment (health care) ◼ percutaneous coronary intervention

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Section: Discussionsupporting

confidence: 59%

Changes in Geographic Variation in the Use of Percutaneous Coronary Intervention for Stable Ischemic Heart Disease After Publication of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) Trial

Mohan

Fazel

Huang

et al. 2014

Circ: Cardiovascular Quality and Outcomes

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“…However, there are many patients with stable coronary disease who continue to receive PCI post-COURAGE.When a major study finds that a widely used medical treatment is no better than a less expensive alternative, do physicians stop using it? The premise behind comparative effectiveness research is that expensive treatments often diffuse into clinical practice without evidence that they are better than existing therapies (Chandra, Jena, and Skinner 2011). Policy makers hope that comparative effectiveness studies will identify ineffective but costly treatments, leading to cost savings.…”

mentioning

confidence: 99%

Trends in PCI Volume after Negative Results from the COURAGE Trial

Howard

Shen

2013

Health Services Research

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“…A peculiar find in health service delivery in Nigerian is the bloatedfocuson curative treatments to the detriment of prevention. Resource limitations should inform research into viable, effective and efficient methods (20) . However, this logic does not seem to reflect in the small number of studies that performedeconomic evaluations.…”

Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness Research (CER) in Nigeria: the Milestones and the Millstones.

Ogaji¹

2012

IOSR-JDMS

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The Pragmatist's Guide to Comparative Effectiveness Research

Cited by 14 publications

References 15 publications

Changes in Geographic Variation in the Use of Percutaneous Coronary Intervention for Stable Ischemic Heart Disease After Publication of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) Trial

Changes in Geographic Variation in the Use of Percutaneous Coronary Intervention for Stable Ischemic Heart Disease After Publication of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) Trial

Trends in PCI Volume after Negative Results from the COURAGE Trial

Comparative Effectiveness Research (CER) in Nigeria: the Milestones and the Millstones.

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