Comparative effectiveness research examines treatment options

by Kalani Simpson, UNMC public relations | February 21, 2014

Image with caption: James O'Dell, M.D., studies the effectiveness of drug therapies for rheumatoid arthritis.

James O'Dell, M.D., studies the effectiveness of drug therapies for rheumatoid arthritis.

Throughout campus, UNMC scientists are using comparative effectiveness research.

It's a science that looks at large data sets, or uses meta-analysis, to evaluate health outcomes. It compares different interventions and strategies to prevent, diagnose, treat and monitor health conditions.

For example:

  • In rheumatology and immunology, James O'Dell, M.D., in his role as chief of the division of rheumatology and immunology for the Veterans Administration Nebraska-Western Iowa Health Care System's Omaha medical center, authored with his colleagues a study comparing the effectiveness of drug therapies for rheumatoid arthritis.
  • In the School of Allied Health Professions, Katherine Jones, Ph.D., and her team study a theory-driven, longitudinal evaluation of the impact of team training on safety culture in hospitals.
  • At the College of Public Health, Preethy Nayar, Ph.D., has two projects comparing outcomes and costs of care with different treatment modalities for elderly pancreatic cancer patients. Chandra Are, M.B.B.S., Fang Yu, Ph.D. and James Schwarz, M.D. are co-investigators.
  • Fausto Loberiza Jr., M.D., is part of a multicenter study testing whether programs improve depression and health-care adherence in hematopoietic stem cell transplant survivors.

And there are more.

"In a typical randomized clinical trial (RCT), a comparison is made between people taking an active drug and those taking an inactive placebo. The question we want to answer is, 'Can the drug work? Is it better than placebo?'" said Gary Cochran, Pharm.D., assistant professor of pharmacy practice.

"But we're trying to answer a broader question. If there are several treatments, which is best and for which group of people?"

Oftentimes this requires a different type of study design. "Typical" RCTs are meant to determine whether a drug is efficacious and are required for drug approval. Comparative effectiveness research (CER), in contrast, is used in real-life conversations between patients and their health care providers -- based on what is known, which treatment is likely best?

"Dr. O'Dell continues to address the most important questions pertaining to rheumatoid arthritis, the questions that matter most to patients. What therapy is best?" said David Wofsy, M.D., past president of the American College of Rheumatology. "In a field that has largely avoided comparative effectiveness trials since the advent of biologic therapies, the triumph of O'Dell's team has been to replace hype with data that compel us to challenge conventional wisdom and keep an open mind. That is clinical science at its best."

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