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Area of Science:

  • Comparative Effectiveness Research
  • Health Services Research
  • Biostatistics

Background:

  • Shared decision-making (SDM) is challenged by assessing multiple treatment outcomes.
  • Generalized pairwise comparisons (GPC) offer a rigorous method for analyzing multi-outcome data.
  • GPC has the potential to enhance SDM by systematically evaluating diverse outcomes.

Purpose of the Study:

  • To evaluate the utility of generalized pairwise comparisons (GPC) in supporting shared decision-making (SDM).
  • To apply GPC to individual patient data from the Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial.

Main Methods:

  • A comparative effectiveness study utilizing data from the multicenter US CODA trial (May 2016-March 2020).
  • Formation of all possible patient pairs across treatment arms (antibiotics vs. appendectomy) for sequential analysis of seven outcomes.
  • Analysis of data between February 2020 and early 2024, considering three distinct prioritization scenarios.

Main Results:

  • The study included 1552 patients (776 per arm).
  • Net treatment benefit (NTB) varied significantly across scenarios: 12.8% favoring antibiotics, 3.2% favoring neither, and -14.5% favoring appendectomy.
  • Results demonstrated that the perceived benefit-risk balance is highly dependent on the prioritization of outcomes.

Conclusions:

  • The GPC method provides a flexible and rigorous quantitative analysis for comparing treatment benefit-risk.
  • GPC offers a nuanced assessment of differences between treatment modalities based on prioritized outcomes.
  • This approach can significantly support SDM by incorporating individual patient priorities for multiple outcomes.