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Comparative effectiveness research: what kind of studies do we need?
John Concato1, Peter Peduzzi, Grant D Huang
1Clinical Epidemiology Research Center, Veterans Affairs (VA) Connecticut Healthcare System, West Haven, CT 06516, USA. john.concato@yale.edu
Summary
The Department of Veterans Affairs has a long history of comparative effectiveness research (CER), comparing treatments to improve patient outcomes. This research includes trials and observational studies, offering valuable insights into medical decision-making.
Area of Science:
- Health Services Research
- Clinical Epidemiology
Background:
- Comparative Effectiveness Research (CER) is a growing field.
- Patient-oriented research comparing therapeutic options has a long history, particularly within the Department of Veterans Affairs (VA).
Observation:
- The VA Cooperative Studies Program conducts multisite randomized controlled trials.
- Observational studies using primary or secondary data collection are also employed.
- Examples span cardiology, including trials on coronary artery bypass grafting, percutaneous coronary intervention versus medical therapy, and medication effects on acute coronary syndrome.
Findings:
- A 1970s VA trial assessed coronary artery bypass grafting for angina.
- A 1990s VA trial, identified as CER, found percutaneous coronary intervention not superior to optimal medical therapy.
- A 2000s VA study linked proton pump inhibitors to reduced clopidogrel effectiveness in acute coronary syndrome.
Implications:
- Reviewing diverse VA study designs highlights the strengths, limitations, and potential of CER.
- VA research provides a robust historical foundation for contemporary CER.
- Understanding past CER methodologies informs future patient-centered outcomes research.
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