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06:55
Inverse Probability of Treatment Weighting (Propensity Score) using the Military Health System Data Repository and National Death Index
Published on: January 8, 2020
How large must a treatment effect be before it matters to practitioners? An estimation method and demonstration
William R Miller1, Jennifer Knapp Manuel
1Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico, USA. wrmiller@unm.edu
Drug and Alcohol Review
|July 9, 2008
Summary
Clinicians define clinically meaningful differences in substance abuse treatment outcomes, such as a 10-12 point improvement in abstinence or employment rates. These practitioner-defined benchmarks can improve the relevance of clinical trials.
Area of Science:
- Addiction Medicine
- Clinical Psychology
- Health Services Research
Background:
- Treatment research often faces criticism for lacking clinical relevance.
- A disconnect exists between statistical significance and clinically meaningful outcomes in substance abuse treatment.
Purpose of the Study:
- To introduce a novel methodology for estimating clinically important differences as perceived by substance abuse practitioners.
- To bridge the gap between statistical findings and practical clinical application in addiction treatment.
Main Methods:
- Surveyed 50 substance abuse treatment providers from the National Institute on Drug Abuse (NIDA) Clinical Trials Network.
- Practitioners identified thresholds for clinically meaningful differences across nine common outcome variables.
- Assessed practitioner interest in adopting new treatments based on effect size.
Main Results:
- A 10-12 point improvement in abstinence, employment, or liver enzyme levels was deemed meaningful.
- A 5 percentage-point reduction in patient mortality was considered clinically significant.
- For continuous outcomes, practitioners considered an effect significant if it doubled or halved the base rate.
Conclusions:
- Statistically significant effects in clinical trials may not always impress practitioners.
- Clinicians' judgments of meaningful differences are crucial for informing the design and power calculations of future clinical trials.
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