"Insufficient Evidence" series by Milwaukee Journal-Sentinel

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The Milwaukee Journal-Sentinel has started another interesting health care series – this one called “Insufficienct Evidence.” First entry: “Health care tries to figure out what works best,” by Guy Boulton.

Borrowing a line from “When Harry Meets Sally,” newspapers across the country should say, “I’ll have whatever she’s having” if they look and see the terrific work that the Milwaukee paper is doing on health care topics. John Fauber’s “Side Effects” series on conflicts of interest in health care has been going on for more than a year.

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Comments (4)

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Greg Pawelski

May 3, 2010 at 1:23 pm

I think one good recent example of comparative effectiveness research in cancer medicine was a Duke University cost savings study on the impact of a chemoresponse assay on treatment costs for recurrent ovarian cancer. They sought to estimate mean costs of chemotherapy treatment with or without use of a chemoresponse assay.
They estimated mean costs for 3 groups: (1) assay assisted: 75 women who received oncologist’s choice of chemotherapy following chemoresponse testing (65% adherence to test results), (2) assay adherent: modeled group assuming 100% adherence to assay results, and (3) empiric: modeled from market share data on most frequently utilized chemotherapy regimens. Cost estimates were based on commercial claims database reimbursements.
The most common chemotherapy regimens used were topotecan, doxorubicin, and carboplatin/paclitaxel. Mean chemotherapy costs for 6 cycles were $48,758 (empiric), $33,187 (assay assisted), and $23,986 (assay adherent). The cost savings related to the assay were associated with a shift from higher- to lower-cost chemotherapy regimens and lower use of supportive drugs such as hematopoiesis-stimulating agents.
Conclusion of the study was that assay-assisted chemotherapy for recurrent ovarian cancer may result in reduced costs compared to empiric therapy. What most medical oncologists do now (PMID: 20417480).
What complex treatment regimens work best for which patients? You’d think that the evidence needed to answer the question for individual cancer patients doesn’t exist. Sometimes the most effective treatment options cost less. Again, you’d think that any savings would be a decade or more away. You’d think that we don’t have enough evidence on how to use the drugs that we already have.
The answer? It’s right there in front of us. Perhaps thinking-outside-the-box would work wonders.


May 5, 2010 at 2:23 am

I consider this blog – and the website – to be a gift to humanity.
One thing I’d like to point out, as a journalist who has reported on health, is the important educational role that experts can play when they are interviewed. Many years ago, when I was just starting out, a doctor took the time to emphasize the rules of reporting on studies as they related to his research. It only took a few minutes, but it made a great impact on me. It showed me how much he cared about the accuracy of the final product and it put his main idea into context in an important way.
Thanks again! I’ll be visiting the blog and site frequently.