scholarly journals The Past, Present, and Future of Comparative Effectiveness Research in the US Department of Veterans Affairs

2010 ◽  
Vol 123 (12) ◽  
pp. e3-e7 ◽  
Author(s):  
Joel Kupersmith ◽  
Alexander K. Ommaya
2012 ◽  
Vol 33 (1) ◽  
pp. E3 ◽  
Author(s):  
Shelly D. Timmons ◽  
Steven A. Toms

Comparative effectiveness research (CER) is emerging as a commonly applied technique to determine the usefulness of medical interventions. Such research aims to compare various treatments for specific disease entities for overall effectiveness and potential for harm. According to the Centers for Disease Control, an estimated 1.7 million patients sustain a traumatic brain injury (TBI) annually in the US. In this review the authors examine the existence of CER reports in the area of neurotrauma to date and consider the context in which clinical research and evidence-based guidelines have and will continue to inform such analyses, with special attention to TBI.


Author(s):  
Adrian Levy ◽  
Robert Platt ◽  
Soko Setoguchi ◽  
Jeffrey Brown ◽  
Michael Paterson

Over the past decade, characterizing the safety and effectiveness of drugs has advanced through distributed networks of data repositories where investigators implement the same procedures to address the same topic using a common data model. Distributed networks for pharmacoepidemiology have now been established in the United States (US), Globally/Europe Canada, and Asian countries. Sentinel in the US was developed in response to legislation and is funded by the US Food and Drug Administration to address their safety queries. The Observational Medical Outcomes Partnership (OMOP) is an international collaborative with a growing European data network that developed a common data model through a public-private partnership. The Canadian Network of Observational Drug Effect Studies (CNODES) receives funding and study queries from Health Canada and dissemination is directly back to the regulator as well as through the peer-reviewed literature. The Asian Pharmacoepidemiology Network (AsPEN) is an investigator-initiated multi-national research network formed to support the safety and effectiveness assessment of medications and other therapeutics and to facilitate the prompt identification and validation of emerging safety issues among the countries in Asia and Pacific regions. While these networks have implemented two different common data models (CNODES with Sentinel, ASPEN with OMOP), each network differs from the others in the aims, stage and implementation, operational approach, data quality assurance mechanisms, funding, and dissemination. The objectives of this session are to compare and contrast the role and goals, design principles, implementation approaches, and analytic conventions and procedures between common data models implemented by SENTINEL, OMOP, CNODES, ands AsPEN. Divided into seven 15-minute segments the session begins with an overview of distributed networks of common data models for pharmacoepidemiology. In four slides, each presenter then characterizes their network by describing the following: number of data holders, lives covered, and records, data holdings, data access model, network governance. process for transforming a repository’s data into the common data model target audience(s), process of identifying queries and knowledge dissemination plan two key challenges faced by the network and the lessons learned In identifying similarities and meaningful differences between the networks, in the next segment the discussant will articulate the relative strengths of the different approaches taken. This will lead into the last segment in which the floor will be opened for questions and comments from the audience. The session would be of benefit to researchers seeking to better understand or join an existing distributed network as well as researchers interested in broadening their understanding of global comparative effectiveness research.


2012 ◽  
Vol 33 (1) ◽  
pp. E8 ◽  
Author(s):  
Nicholas F. Marko ◽  
Robert J. Weil

Considerable financial and human resources have been directed toward the emerging field of comparative effectiveness research (CER) in the US. Fundamentally, the concept of CER is so logical as to be almost self-evident; namely, that research regarding therapeutic strategies should go beyond efficacy and examine objectively their real-world effects and outcomes. In practice, however, reluctance to consider difficult questions related to the many dimensions of value in health care delivery and corresponding legislative constraints placed on the US CER enterprise risk limiting the ultimate utility of this investigative model. Significant constraints have been codified into the patient-centered outcomes research (PCOR) model of CER, which is emerging as the de facto method for conducting CER in the US. The experience of the authors as clinicians attempting to use CER to improve complex management decisions, for which multidimensional considerations of value represent a critical component of the overall effectiveness of alternate strategies, highlight the inability of PCOR to comprehensively inform this process. This suggests that PCOR may be a suboptimal approach for performing clinically relevant CER. In this editorial, the authors use clinical examples to highlight the limitations of the PCOR approach to CER and to propose an alternate approach, which they term “comparative, value-based effectiveness research” (CVER). The authors believe that the narrow scope and fundamental limitations of PCOR mitigate its overall value to medical decision-makers attempting to optimize overall effectiveness in the real-world setting, while a more comprehensive approach like CVER has greater potential to realize practical benefits for patients, clinicians, and society as a whole.


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