Translating Comparative Effectiveness Research Evidence to Real-World Decision Making: Some Practical Considerations

Abstract

For quite some time, there has been an understanding by both clinicians and payers that a given treatment may not be appropriate or justifiable for a broad patient population. The recently increased emphasis on comparative effectiveness research (CER) has heightened both the level of evidence and awareness related to the potential for better targeting of treatments. However, a number of practical hurdles to implementation of such targeting by clinical and payer decision makers remain. Such hurdles can be related to the ability to interpret or confirm the evidence relating to differences in patient physiologic responses to treatment, to the practicality of predicting such responses for individual patients in real-world treatment settings, to understanding differences in patient behavior and/or the cost consequences related to treatment that may affect choices, or to ethical considerations, among other things. This chapter will review and discuss these practical considerations, not only reviewing the literature but also providing some specific case examples. The goal of this chapter is to provide some perspective and guidance on the translation and implementation of CER and evidence on heterogeneity of treatment effects to real-world patients and their treatment.