All over campus, UNMC scientists are using comparative effectiveness research.
It’s a science that looks at large data sets, or uses meta-analysis, to evaluate health outcomes. It compares different interventions and strategies to prevent, diagnose, treat and monitor health conditions.
For example:
- In rheumatology and immunology, James O’Dell, M.D., also in his role as chief of the Veterans Administration Nebraska-Western Iowa Health Care System’s Omaha medical center, and his colleagues, authored a study comparing the effectiveness of drug therapies for rheumatoid arthritis.
- In the School of Allied Health Professions, Katherine Jones, Ph.D., and her team study a theory-driven, longitudinal evaluation of the impact of team training on safety culture in hospitals.
- At the College of Public Health, Preethy Nayar, Ph.D., has two projects comparing outcomes and costs of care with different treatment modalities for elderly pancreatic cancer patients. Drs. Chandra Are, Fang Yu, Ph.D. and James Schwarz, M.D. are co-investigators.
Fausto Loberiza Jr., M.D., is part of a multicenter study testing whether programs improve depression and health-care adherence in hematopoietic stem cell transplant survivors.
And there are more.
“In a typical randomized clinical trial (RCT) a comparison is made between people taking an active drug and those taking an inactive placebo. The question we want to answer is, ‘can the drug work? Is it better than placebo?’” said Gary Cochran, Pharm.D., assistant professor of pharmacy practice.
“But we’re trying to answer a broader question. If there are several treatments, which is best and for which group of people?”
Oftentimes this requires a different type of study design. “Typical” RCTs are meant to determine whether a drug is efficacious and are required for drug approval. Comparative effectiveness research (CER), in contrast, is used in real-life conversations between patients and their health care providers. Based on what we know, which treatment is likely best for you? How can narrowing down all of this knowledge be used in my individual treatment plan?
“Dr. O’Dell continues to address the most important questions pertaining to rheumatoid arthritis, the questions that matter most to patients. What therapy is best?” said David Wofsy, M.D., past president of the American College of Rheumatology. “In a field that has largely avoided comparative effectiveness trials since the advent of biologic therapies, the triumph of O’Dell’s team has been to replace hype with data that compel us to challenge conventional wisdom and keep an open mind. That is clinical science at its best.”
To provide this information, comparative effectiveness research must assess a comprehensive array of health-related outcomes for diverse patient populations.
Investigators can look at several variables — age, gender, genomics, ethnic group. They can pool data from previous trials, even tap into hospital and insurance data sets.
Thus, they can get an idea of what will work not just for the people carefully selected for a study group — but all kinds of people.
You’re probably not going to get as precise an answer as you would with a single clinical trial. But then, that isn’t the goal.
“If you’re a physician treating a patient with high blood pressure,” Dr. Cochran said, “you can’t just throw up your hands and say ‘I don’t know.’ CER compares all of the relevant treatment options and provides patients and clinicians with evidence-based information to help select the best treatment option for the individual.
“So, when the doctor and the patient have that conversation, where do we start? What’s the evidence out there? We pool all of our data, we look at people like you … and identify the treatments most likely to work.”