The case for a comparative, value-based alternative to the patient-centered outcomes research model for comparative effectiveness research.

Abstract:

: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.

journal_name

Neurosurg Focus

journal_title

Neurosurgical focus

authors

Marko NF,Weil RJ

doi

10.3171/2012.5.FOCUS12127

subject

Has Abstract

pub_date

2012-07-01 00:00:00

pages

E8

issue

1

issn

1092-0684

journal_volume

33

pub_type

社论
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    authors: Faggin R,Calderone M,Denaro L,Meneghini L,d'Avella D

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    authors: Commins DL,Atkinson RD,Burnett ME

    更新日期:2007-01-01 00:00:00

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    authors: Liu JK,Kan P,Karwande SV,Couldwell WT

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    authors: Awad I,Jabbour P

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    pub_type: 杂志文章

    doi:

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  • Decision making for the surgical approach of posterior petrous bone meningiomas.

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