Methods for Comparative
Effectiveness and HSR
Andrew F
F. Nelson
AcademyHealth Annual Research Meeting
Sunday,
S d June
J
27,
27 2010
Boston, MA
Topics
CER in Health Care Delivery Systems
Use of CER Knowledge by Care Delivery
Health Plan Benefit Design Using CER
To Optimize Health and Health Care
Comparative Effectiveness Research in
Health Care Delivery Systems
• CERGEN-C= Comparative Effectiveness
R
Research
h in
i Genomics
G
i &P
Personalized
li d Medicine
M di i
for Colorectal Cancer
Cancer Research Network (CRN)
Virtual Data Warehouse (VDW)
Version 3
R
Research
h Site
Sit C
Capabilities
biliti and
dC
Capacities
iti
•
•
•
•
•
•
•
•
•
Tumor/Data Repository
Method of Storage
W itt Policies
Written
P li i and
dP
Procedures
d
Data Access Committee
Established Price Structure
Experience Using Resource
Investigator Collaborator
R
Research
h IInfrastructure
f t t
Institutional Goodwill
Project 1: Evidence Synthesis
H i
Horizon
Scanning
S
i
Systematic Review
on KRAS Testing
Rapid,
p , Targeted
g
Reviews for
Additional
CRC l t d GPM
CRC-related
Applications
Expansion of
EGAPP Methods
Project 2: Cost Effectiveness
• Cost-Effectiveness for Lynch Syndrome
– Building upon model developed for CRC screening
– Incorporate families and relationships in model
– Uses LS screening strategies from EGAPP review
• Cost-Effectiveness for KRAS
– Considers treatment costs for cetuximab and
panitumumab
– Considers genotyping for KRAS, BRAF, and others
Project 2: Cost Effectiveness
Cost Effectiveness for Lynch Syndrome
Cost-Effectiveness
Cancer
State at
Start of Year
Symptoms
S
Sensitivity
iti it
Severity
Specificity
Options
Potential
Harms*
Screening Diagnostics Treatments
Disease
Severity
Strategy
Adherence
Technology
USPSTF
Guidelines
Cancer
State at
End of Year
Project 3: Utilization
Variables to Assess
Use of KRAS
Testing
Project 4: Comparative Effectiveness
2005- 2007
2005
2008- 2010
2008
KRAS Mutation (40%)
KRAS Mutation (40%)
Project 5: Psychosocial Issues
Acknowledgements
g
Co-PIs

 Katrina Goddard, KPNW
Kushi, KPNC
 Larry Kushi
 Evelyn Whitlock, KPNW






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Project Leads






Jennifer Lin
Lin, KPNW
Michael Maciosek, HPRF
Katrina Goddard, KPNW
H th FFeigelson,
Heather
i l
KPCO
Carol Somkin, KPNC
Additional Site PIs





Andrew Williams, KPH
Catherine McCarty, MCRF
Pamala Pawloski, HPRF
Gwen Alexander, HFHS
Co-Investigators

Bob Davis, KPG
Thom Flottemesch
Flottemesch, HPRF
Richard Meenan, KPNW
Andrew Nelson, HPRF
Suzanne O
O’Neill
Neill, GU
Arnie Potosky, GU
Alanna Rahm, KPCO
Consultants





Ned Colange, DPH CO
L i LLeMarchand,
Loic
M h d UH
Sue Richards, OHSU
David Veenstra, UW

Oncologists/Clinicians



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


A. Onitilo, MCRF
J C
J.
Carney, KPH
N. Tirumali, KPNW
C. Hwang, HFHS
T Kolevska,
T.
K l k KPNC
A. Mentor, KPCO
Funded by a grant from
the National Cancer
Institute, RC2-CA148471.
CER Health Care Delivery Examples…
Examples
• Prevention Priorities, CDC&P and RWJF
• Diagnosis and Treatment for Depression:
Di
Diamond,
d NIMH
• Use of Electronic Medical Record to
I di id li T
Individualize
Treatment
t
tP
Priorities
i iti ffor
Chronic Diseases, NIH:NIHLBI,NIDCR
Use of CER Knowledge
by Care Delivery
• Clinical Inertia
– Medical Education
– Delivery Team/Site System
– Community Standard
• Consumer/Patient/Member Desire
– Trust in Provider
– Community Belief
– Direct Advertizing
– New
– More
Health Plan Benefit Design
Using CER
•
•
•
•
•
•
Employer, Especially Self Insured as Drivers
Fear of Rationing
History of Technology Assessment
CER Does Not Include Cost, Who are You Kidding?
Disconnect with Public Policy Makers
Drug and Device Industry Influence
To Optimizing Health
and Health Care
• Needed Community Approach to Drive Quality and Value
• Community Measurement and Public Reporting
• Use of Health Information Technology to Inform Care
Decisions by providers and patients/families
• Evidence
E id
B
Based
dH
Health
lth Pl
Plan B
Benefit
fit
• CER investments timing, increasingly NOT investigator
initiated
• Designing Innovation in or out of Health Care
• Academia
A d i and
d IIndustry
d t weakk partners
t
in
i CER,
CER Li
Limited
it d
Capacity within Health Care Delivery Systems
• Methods Flexibility
Flexibility, Traditional Reviewers/ers inadequate