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DEMYSTIFYING COMPARATIVE
EFFECTIVENESS RESEARCH:
A CASE STUDY LEARNING GUIDE
ROBERT W. DUBOIS, MD, PhD
SYLVIA L. KINDERMANN, MPH
November 2009
A White Paper Prepared
\ue000or NPC by
AUTHORS:
Robert W. Dubois, MD, PhD
Chie\ue000 Medical Ofcer, Cerner Li\ue000eSciences
Sylvia L. Kindermann, MPH
Sr. Research Associate, Cerner Li\ue000eSciences

Acknowledgments: The authors would like to acknowledge Diana Enyedi, Jenni\ue000er Graf,
Andrea Ho\ue000elich, Les Paul, Gary Persinger, Sabrina Siddiqui, and Kimberly Westrich \ue000or their
thought\ue000ul contributions to this report.

Funded and published by the National Pharmaceutical Council. Copyright 2009.
For copies o\ue000 this report, please contact the National Pharmaceutical Council at 703-620-6390
or visit www.npcnow.org.
ExEcutivE Summary
I. Introduction

D\ue00bcisions m\ue009d\ue00b \ue00a\ue00f p\ue009ti\ue00bnts \ue009nd ph\ue00fsici\ue009ns \ue009\ue00aout th\ue00b c\ue009r\ue00b th\ue009t th\ue00b
p\ue009ti\ue00bnt wi\ue00d\ue00d r\ue00bc\ue00biv\ue00b \ue00cr\ue00bqu\ue00bnt\ue00d\ue00f invo\ue00dv\ue00b choic\ue00bs \ue009mong \ue009v\ue009i\ue00d\ue009\ue00a\ue00d\ue00b th\ue00br\ue009pi\ue00bs.
Common\ue00d\ue00f, th\ue00br\ue00b \ue009r\ue00b \ue00c\ue00bw r\ue00bs\ue00b\ue009rch studi\ue00bs th\ue009t comp\ue009r\ue00b \ue009\ue00dt\ue00brn\ue009tiv\ue00b
tr\ue00b\ue009tm\ue00bnts \ue009nd provid\ue00b \ue00bvid\ue00bnc\ue00b to guid\ue00b \ue009 p\ue009rticu\ue00d\ue009r d\ue00bcision. Ev\ue00bn
\ue00d\ue00bss p\ue00d\ue00bnti\ue00cu\ue00d \ue009r\ue00b studi\ue00bs th\ue009t comp\ue009r\ue00b tr\ue00b\ue009tm\ue00bnt options in r\ue00b\ue009\ue00d-wor\ue00dd
s\ue00bttings. As th\ue00b r\ue00b\ue009\ue00di\ue010\ue009tion o\ue00c this n\ue00b\ue00bd \ue00cor \ue00bnh\ue009nc\ue00bd comp\ue009r\ue009tiv\ue00b
in\ue00corm\ue009tion to \ue009chi\ue00bv\ue00b \ue00a\ue00bst outcom\ue00bs h\ue009s grown, \ue009tt\ue00bntion h\ue009s \ue00cocus\ue00bd
on comp\ue009r\ue009tiv\ue00b \ue00b\ue002\ue00bctiv\ue00bn\ue00bss r\ue00bs\ue00b\ue009rch. Th\ue00b Institut\ue00b o\ue00c M\ue00bdicin\ue00b d\ue00b\ue001n\ue00bs
this Comp\ue009r\ue009tiv\ue00b E\ue002\ue00bctiv\ue00bn\ue00bss R\ue00bs\ue00b\ue009rch (CER) \ue009s:

\u201c...the generation and synthesis o\ue000 evidence that compares the
benefts and harms o\ue000 alternative methods to prevent, diagnose, treat,
and monitor a clinical condition or to improve the delivery o\ue000 care.
The purpose o\ue000 CER is to assist consumers, clinicians, purchasers and
policymakers to make in\ue000ormed decisions that will improve health
care at both the individual and population levels.\u201d\ue003

With th\ue00b curr\ue00bnt n\ue009tion\ue009\ue00d \ue00cocus on improving our h\ue00b\ue009\ue00dth c\ue009r\ue00b s\ue00fst\ue00bm,
CER h\ue009s r\ue00bc\ue00biv\ue00bd su\ue00ast\ue009nti\ue009\ue00d \ue009tt\ue00bntion. In \ue009ddition, in \ue00b\ue009r\ue00d\ue00f \ue004009, th\ue00b
Am\ue00bric\ue009n R\ue00bcov\ue00br\ue00f \ue009nd R\ue00binv\ue00bstm\ue00bnt Act \ue009\ue00d\ue00doc\ue009t\ue00bd $\ue003.\ue003 \ue00ai\ue00d\ue00dion in n\ue00bw
\ue00cunds to incr\ue00b\ue009s\ue00b th\ue00b num\ue00a\ue00br o\ue00c n\ue00bw CER studi\ue00bs. Thr\ue00b\ue00b import\ue009nt
t\ue00fp\ue00bs o\ue00c comp\ue009r\ue009tiv\ue00b \ue00b\ue002\ue00bctiv\ue00bn\ue00bss r\ue00bs\ue00b\ue009rch inc\ue00dud\ue00b: \ue003) R\ue009ndomi\ue010\ue00bd
Contro\ue00d\ue00d\ue00bd Tri\ue009\ue00ds (RCTs), \ue004) M\ue00bt\ue009-An\ue009\ue00d\ue00fsis, \ue009nd \ue005) O\ue00as\ue00brv\ue009tion\ue009\ue00d Studi\ue00bs.
I\ue00c conduct\ue00bd \ue009nd int\ue00brpr\ue00bt\ue00bd corr\ue00bct\ue00d\ue00f, th\ue00bs\ue00b t\ue00fp\ue00bs o\ue00c r\ue00bs\ue00b\ue009rch c\ue009n h\ue00b\ue00dp
to in\ue00corm h\ue00b\ue009\ue00dth c\ue009r\ue00b d\ue00bcision-m\ue009king. I\ue00c, how\ue00bv\ue00br, such studi\ue00bs \ue009r\ue00b
conduct\ue00bd or int\ue00brpr\ue00bt\ue00bd incorr\ue00bct\ue00d\ue00f, th\ue00b comp\ue009r\ue009tiv\ue00b \ue009nsw\ue00brs \ue00crom
th\ue00bs\ue00b studi\ue00bs m\ue009\ue00f \ue00a\ue00b in\ue009ccur\ue009t\ue00b, or wors\ue00b, mis\ue00d\ue00b\ue009ding. This whit\ue00b p\ue009p\ue00br
wi\ue00d\ue00d r\ue00bvi\ue00bw th\ue00b thr\ue00b\ue00b CER stud\ue00f t\ue00fp\ue00bs, discuss th\ue00bir prop\ue00br m\ue00bthodo\ue00dogic
\ue009ppro\ue009ch\ue00bs, \ue009nd provid\ue00b too\ue00ds \ue00cor CER consum\ue00brs to us\ue00b wh\ue00bn th\ue00b\ue00f
r\ue00bvi\ue00bw th\ue00bm. A\ue00dthough \ue009ddition\ue009\ue00d t\ue00fp\ue00bs o\ue00c \ue00aiom\ue00bdic\ue009\ue00d r\ue00bs\ue00b\ue009rch \ue009r\ue00b v\ue00br\ue00f
us\ue00b\ue00cu\ue00d in und\ue00brst\ue009nding dis\ue00b\ue009s\ue00b \ue009nd d\ue00bv\ue00b\ue00doping n\ue00bw drugs, th\ue00b \ue00cocus o\ue00c
this p\ue009p\ue00br is so\ue00d\ue00b\ue00d\ue00f on th\ue00b most common t\ue00fp\ue00bs o\ue00c r\ue00bs\ue00b\ue009rch us\ue00bd \ue00cor CER.

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