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HETEROGENEITY IN ACTION: THE ROLE OF PASSIVE PERSONALIZATION IN COMPARATIVE EFFECTIVENESS RESEARCH
Author(s) -
Basu Anirban,
Jena Anupam B.,
Goldman Dana P.,
Philipson Tomas J.,
Dubois Robert
Publication year - 2014
Publication title -
health economics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.55
H-Index - 109
eISSN - 1099-1050
pISSN - 1057-9230
DOI - 10.1002/hec.2996
Subject(s) - personalization , comparative effectiveness research , context (archaeology) , clinical practice , medicaid , action (physics) , medicine , psychology , instrumental variable , health care , alternative medicine , family medicine , computer science , political science , business , marketing , paleontology , physics , pathology , quantum mechanics , law , biology , machine learning
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.