HETEROGENEITY IN ACTION: THE ROLE OF PASSIVE PERSONALIZATION IN COMPARATIVE EFFECTIVENESS RESEARCH |
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| Authors: | Anirban Basu Anupam B. Jena Dana P. Goldman Tomas J. Philipson Robert Dubois |
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| Affiliation: | 1. Department of Health Services, University of Washington, Seattle and the National Bureau of Economic Research, Cambridge MA, Seattle, WA, USA;2. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA;3. Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, California, USA;4. Irving B. Harris School of Public Policy Studies, University of Chicago, Chicago, USA;5. National Pharmaceutical Council, Washington, D.C., USA |
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| Abstract: | Despite the goal of comparative effectiveness research (CER) to inform patient‐centered care, most studies fail to account for the patient‐centeredness of care that already exist in practice, which we denote as passive personalization (PP). Because CER studies describe the average effectiveness of treatments rather than heterogeneity in how individual patients respond to therapies, clinical or coverage policies that respond to CER results may undermine PP in clinical practice and generate worse outcomes. We study this phenomenon empirically in the context of use of antipsychotic drugs in Medicaid patients with schizophrenia using novel instrumental variable methods. We find strong support for PP in clinical practice and demonstrate that the average effects from a CER study cannot be replicated in practice because of the presence of PP. In contrast, providing physicians with evidence to further personalize treatment can produce significant benefits. Copyright © 2013 John Wiley & Sons, Ltd. |
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| Keywords: | comparative effectiveness heterogeneity passive personalization schizophrenia antipsychotic drugs |
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