Comparative Effectiveness Research (CER) is a multidisciplinary field that focuses on evaluating the comparative benefits and risks of different medical treatments, interventions, and healthcare strategies. Its aim is to provide evidence-based information to support healthcare decision-making by patients, clinicians, policymakers, and other stakeholders.
Comparative Effectiveness Research is a scientific investigation that compares the outcomes of different healthcare interventions and strategies to determine which ones are the most effective for specific patient populations or health conditions. It emphasizes the real-world effectiveness of treatments, taking into account not only clinical outcomes but also patient preferences, costs, and potential harms.
Key Principles of Comparative Effectiveness Research
CER is guided by several key principles:
Patient-Centeredness: CER prioritizes the needs, preferences, and values of patients, ensuring that research questions and outcomes are relevant to them.
Comparisons: It involves rigorous comparisons between different interventions, including existing treatments, new therapies, or alternative healthcare approaches.
Real-World Settings: CER often takes place in real-world clinical settings, providing insights into how treatments perform in everyday practice.
Holistic Assessment: CER considers a broad range of outcomes, including clinical effectiveness, safety, patient-reported outcomes, and cost-effectiveness.
Transparency: Transparency in research methods, data sources, and findings is critical to the credibility and utility of CER.
Methods and Methodologies in Comparative Effectiveness Research
CER employs a variety of research methods and methodologies to assess the comparative effectiveness of healthcare interventions:
Randomized Controlled Trials (RCTs): RCTs are considered the gold standard in clinical research and are often used in CER to compare the effectiveness of two or more interventions by randomly assigning patients to different treatment groups.
Observational Studies: Observational studies, including cohort studies and case-control studies, analyze data from patients receiving different treatments to identify associations and potential differences in outcomes.
Meta-Analysis: Meta-analysis pools data from multiple studies to provide a more comprehensive overview of treatment effectiveness.
Cost-Effectiveness Analysis (CEA): CEA evaluates the cost-effectiveness of interventions by comparing the costs and health outcomes of different treatments.
Systematic Reviews: Systematic reviews synthesize evidence from multiple studies to provide a comprehensive summary of the available research on a particular healthcare intervention.
Applications of Comparative Effectiveness Research
Comparative Effectiveness Research has a wide range of applications:
Clinical Decision-Making: CER helps clinicians make informed treatment decisions by providing evidence on the relative effectiveness and safety of different interventions.
Policy and Guidelines: Policymakers use CER to inform healthcare policies, guidelines, and coverage decisions, with the aim of optimizing healthcare resource allocation.
Drug and Medical Device Approval: Regulatory agencies use CER to evaluate and approve new drugs and medical devices by comparing their effectiveness to existing treatments.
Patient Empowerment: CER empowers patients to make informed decisions about their healthcare by providing information about the benefits, risks, and alternatives to different treatments.
Healthcare Quality Improvement: CER informs efforts to improve the quality and efficiency of healthcare delivery by identifying best practices and reducing unwarranted variations in care.
Challenges in Comparative Effectiveness Research
CER faces several challenges:
Data Quality and Availability: Access to high-quality data and relevant patient outcomes can be limited, especially in real-world settings.
Bias and Confounding: Observational studies are prone to bias and confounding factors that may affect the accuracy of comparative effectiveness assessments.
Patient Heterogeneity: Patients are diverse in terms of genetics, comorbidities, and preferences, which can complicate comparisons and generalizability.
Long-Term Outcomes: Some health conditions and interventions require long-term follow-up to assess effectiveness fully, which can be resource-intensive.
Healthcare Costs: Evaluating the cost-effectiveness of interventions can be challenging, as it requires considering both short-term and long-term economic impacts.
The Future of Comparative Effectiveness Research
The field of Comparative Effectiveness Research is poised for growth and innovation:
Big Data and AI: Advances in data analytics, artificial intelligence, and machine learning will enhance the capacity to analyze large-scale healthcare data.
Precision Medicine: CER will increasingly incorporate genetic and molecular data to tailor treatments to individual patients.
Patient-Reported Outcomes: A greater emphasis on incorporating patient-reported outcomes will provide insights into treatment effectiveness from the patient’s perspective.
Global Collaboration: International collaboration will expand, allowing for cross-country comparisons and broader generalizability of findings.
Real-World Evidence: The use of real-world evidence from electronic health records and health systems will become more common.
Conclusion
Comparative Effectiveness Research is a critical field that contributes to evidence-based decision-making in healthcare. By rigorously comparing the effectiveness of different interventions and strategies, CER improves patient care, informs healthcare policy, and enhances resource allocation. As the healthcare landscape continues to evolve, the role of CER in improving the quality, safety, and efficiency of healthcare delivery will remain pivotal. Researchers, clinicians, policymakers, and patients alike benefit from the insights generated by CER, ultimately leading to better health outcomes and improved healthcare decision-making.
Convergent thinking occurs when the solution to a problem can be found by applying established rules and logical reasoning. Whereas divergent thinking is an unstructured problem-solving method where participants are encouraged to develop many innovative ideas or solutions to a given problem. Where convergent thinking might work for larger, mature organizations where divergent thinking is more suited for startups and innovative companies.
The concept of cognitive biases was introduced and popularized by the work of Amos Tversky and Daniel Kahneman in 1972. Biases are seen as systematic errors and flaws that make humans deviate from the standards of rationality, thus making us inept at making good decisions under uncertainty.
Second-order thinking is a means of assessing the implications of our decisions by considering future consequences. Second-order thinking is a mental model that considers all future possibilities. It encourages individuals to think outside of the box so that they can prepare for every and eventuality. It also discourages the tendency for individuals to default to the most obvious choice.
Lateral thinking is a business strategy that involves approaching a problem from a different direction. The strategy attempts to remove traditionally formulaic and routine approaches to problem-solving by advocating creative thinking, therefore finding unconventional ways to solve a known problem. This sort of non-linear approach to problem-solving, can at times, create a big impact.
Bounded rationality is a concept attributed to Herbert Simon, an economist and political scientist interested in decision-making and how we make decisions in the real world. In fact, he believed that rather than optimizing (which was the mainstream view in the past decades) humans follow what he called satisficing.
The Dunning-Kruger effect describes a cognitive bias where people with low ability in a task overestimate their ability to perform that task well. Consumers or businesses that do not possess the requisite knowledge make bad decisions. What’s more, knowledge gaps prevent the person or business from seeing their mistakes.
Occam’s Razor states that one should not increase (beyond reason) the number of entities required to explain anything. All things being equal, the simplest solution is often the best one. The principle is attributed to 14th-century English theologian William of Ockham.
The Lindy Effect is a theory about the ageing of non-perishable things, like technology or ideas. Popularized by author Nicholas Nassim Taleb, the Lindy Effect states that non-perishable things like technology age – linearly – in reverse. Therefore, the older an idea or a technology, the same will be its life expectancy.
Antifragility was first coined as a term by author, and options trader Nassim Nicholas Taleb. Antifragility is a characteristic of systems that thrive as a result of stressors, volatility, and randomness. Therefore, Antifragile is the opposite of fragile. Where a fragile thing breaks up to volatility; a robust thing resists volatility. An antifragile thing gets stronger from volatility (provided the level of stressors and randomness doesn’t pass a certain threshold).
Systems thinking is a holistic means of investigating the factors and interactions that could contribute to a potential outcome. It is about thinking non-linearly, and understanding the second-order consequences of actions and input into the system.
Vertical thinking, on the other hand, is a problem-solving approach that favors a selective, analytical, structured, and sequential mindset. The focus of vertical thinking is to arrive at a reasoned, defined solution.
Maslow’s Hammer, otherwise known as the law of the instrument or the Einstellung effect, is a cognitive bias causing an over-reliance on a familiar tool. This can be expressed as the tendency to overuse a known tool (perhaps a hammer) to solve issues that might require a different tool. This problem is persistent in the business world where perhaps known tools or frameworks might be used in the wrong context (like business plans used as planning tools instead of only investors’ pitches).
The Peter Principle was first described by Canadian sociologist Lawrence J. Peter in his 1969 book The Peter Principle. The Peter Principle states that people are continually promoted within an organization until they reach their level of incompetence.
The straw man fallacy describes an argument that misrepresents an opponent’s stance to make rebuttal more convenient. The straw man fallacy is a type of informal logical fallacy, defined as a flaw in the structure of an argument that renders it invalid.
The Streisand Effect is a paradoxical phenomenon where the act of suppressing information to reduce visibility causes it to become more visible. In 2003, Streisand attempted to suppress aerial photographs of her Californian home by suing photographer Kenneth Adelman for an invasion of privacy. Adelman, who Streisand assumed was paparazzi, was instead taking photographs to document and study coastal erosion. In her quest for more privacy, Streisand’s efforts had the opposite effect.
As highlighted by German psychologist Gerd Gigerenzer in the paper “Heuristic Decision Making,” the term heuristic is of Greek origin, meaning “serving to find out or discover.” More precisely, a heuristic is a fast and accurate way to make decisions in the real world, which is driven by uncertainty.
The recognition heuristic is a psychological model of judgment and decision making. It is part of a suite of simple and economical heuristics proposed by psychologists Daniel Goldstein and Gerd Gigerenzer. The recognition heuristic argues that inferences are made about an object based on whether it is recognized or not.
The representativeness heuristic was first described by psychologists Daniel Kahneman and Amos Tversky. The representativeness heuristic judges the probability of an event according to the degree to which that event resembles a broader class. When queried, most will choose the first option because the description of John matches the stereotype we may hold for an archaeologist.
The take-the-best heuristic is a decision-making shortcut that helps an individual choose between several alternatives. The take-the-best (TTB) heuristic decides between two or more alternatives based on a single good attribute, otherwise known as a cue. In the process, less desirable attributes are ignored.
The bundling bias is a cognitive bias in e-commerce where a consumer tends not to use all of the products bought as a group, or bundle. Bundling occurs when individual products or services are sold together as a bundle. Common examples are tickets and experiences. The bundling bias dictates that consumers are less likely to use each item in the bundle. This means that the value of the bundle and indeed the value of each item in the bundle is decreased.
The Barnum Effect is a cognitive bias where individuals believe that generic information – which applies to most people – is specifically tailored for themselves.
First-principles thinking – sometimes called reasoning from first principles – is used to reverse-engineer complex problems and encourage creativity. It involves breaking down problems into basic elements and reassembling them from the ground up. Elon Musk is among the strongest proponents of this way of thinking.
The ladder of inference is a conscious or subconscious thinking process where an individual moves from a fact to a decision or action. The ladder of inference was created by academic Chris Argyris to illustrate how people form and then use mental models to make decisions.
Goodhart’s Law is named after British monetary policy theorist and economist Charles Goodhart. Speaking at a conference in Sydney in 1975, Goodhart said that “any observed statistical regularity will tend to collapse once pressure is placed upon it for control purposes.” Goodhart’s Law states that when a measure becomes a target, it ceases to be a good measure.
The Six Thinking Hats model was created by psychologist Edward de Bono in 1986, who noted that personality type was a key driver of how people approached problem-solving. For example, optimists view situations differently from pessimists. Analytical individuals may generate ideas that a more emotional person would not, and vice versa.
The Mandela effect is a phenomenon where a large group of people remembers an event differently from how it occurred. The Mandela effect was first described in relation to Fiona Broome, who believed that former South African President Nelson Mandela died in prison during the 1980s. While Mandela was released from prison in 1990 and died 23 years later, Broome remembered news coverage of his death in prison and even a speech from his widow. Of course, neither event occurred in reality. But Broome was later to discover that she was not the only one with the same recollection of events.
The bandwagon effect tells us that the more a belief or idea has been adopted by more people within a group, the more the individual adoption of that idea might increase within the same group. This is the psychological effect that leads to herd mentality. What in marketing can be associated with social proof.
Moore’s law states that the number of transistors on a microchip doubles approximately every two years. This observation was made by Intel co-founder Gordon Moore in 1965 and it become a guiding principle for the semiconductor industry and has had far-reaching implications for technology as a whole.
Disruptive innovation as a term was first described by Clayton M. Christensen, an American academic and business consultant whom The Economist called “the most influential management thinker of his time.” Disruptive innovation describes the process by which a product or service takes hold at the bottom of a market and eventually displaces established competitors, products, firms, or alliances.
Value migration was first described by author Adrian Slywotzky in his 1996 book Value Migration – How to Think Several Moves Ahead of the Competition. Value migration is the transferal of value-creating forces from outdated business models to something better able to satisfy consumer demands.
The bye-now effect describes the tendency for consumers to think of the word “buy” when they read the word “bye”. In a study that tracked diners at a name-your-own-price restaurant, each diner was asked to read one of two phrases before ordering their meal. The first phrase, “so long”, resulted in diners paying an average of $32 per meal. But when diners recited the phrase “bye bye” before ordering, the average price per meal rose to $45.
Groupthink occurs when well-intentioned individuals make non-optimal or irrational decisions based on a belief that dissent is impossible or on a motivation to conform. Groupthink occurs when members of a group reach a consensus without critical reasoning or evaluation of the alternatives and their consequences.
A stereotype is a fixed and over-generalized belief about a particular group or class of people. These beliefs are based on the false assumption that certain characteristics are common to every individual residing in that group. Many stereotypes have a long and sometimes controversial history and are a direct consequence of various political, social, or economic events. Stereotyping is the process of making assumptions about a person or group of people based on various attributes, including gender, race, religion, or physical traits.
Murphy’s Law states that if anything can go wrong, it will go wrong. Murphy’s Law was named after aerospace engineer Edward A. Murphy. During his time working at Edwards Air Force Base in 1949, Murphy cursed a technician who had improperly wired an electrical component and said, “If there is any way to do it wrong, he’ll find it.”
The law of unintended consequences was first mentioned by British philosopher John Locke when writing to parliament about the unintended effects of interest rate rises. However, it was popularized in 1936 by American sociologist Robert K. Merton who looked at unexpected, unanticipated, and unintended consequences and their impact on society.
Fundamental attribution error is a bias people display when judging the behavior of others. The tendency is to over-emphasize personal characteristics and under-emphasize environmental and situational factors.
Outcome bias describes a tendency to evaluate a decision based on its outcome and not on the process by which the decision was reached. In other words, the quality of a decision is only determined once the outcome is known. Outcome bias occurs when a decision is based on the outcome of previous events without regard for how those events developed.
Hindsight bias is the tendency for people to perceive past events as more predictable than they actually were. The result of a presidential election, for example, seems more obvious when the winner is announced. The same can also be said for the avid sports fan who predicted the correct outcome of a match regardless of whether their team won or lost. Hindsight bias, therefore, is the tendency for an individual to convince themselves that they accurately predicted an event before it happened.
Gennaro is the creator of FourWeekMBA, which reached about four million business people, comprising C-level executives, investors, analysts, product managers, and aspiring digital entrepreneurs in 2022 alone | He is also Director of Sales for a high-tech scaleup in the AI Industry | In 2012, Gennaro earned an International MBA with emphasis on Corporate Finance and Business Strategy.
Discover more from FourWeekMBA
Subscribe now to keep reading and get access to the full archive.
