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Comparative Effectiveness Research in Health Services

Tan, Jonathan M. MD, MPH; Wasey, Jack O. BM BCh, MA, MSci, MSc; Simpao, Allan F. MD, MBI

doi: 10.1213/ANE.0000000000002522
Books, Multimedia, and Meeting Reviews
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Published ahead of print October 5, 2017.

Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, simpaoa@email.chop.edu

Published ahead of print October 5, 2017.

Ongoing changes to health care systems around the world have made optimizing value in health care a worldwide priority. As a result, relative effectiveness and costs of care have gained prominence in medical decision making and policy. The field of comparative effectiveness research (CER) seeks to identify what works best for which patients under what circumstances and to deliver “the right treatment for the right patient at the right time.” The book Comparative Effectiveness Research in Health Services, edited by Adrian Levy and Boris Sobolev, presents perspectives on CER across 356 pages and 20 chapters and best serves as a reference book for individuals seeking standalone essays that discuss various aspects of CER. The topics covered are comprehensive with regard to CER and provide a solid foundation for health care professionals who wish to learn about the value and implementation science of CER. While the print version was used for this review, a digital version exists with hyperlinked figures, citations, authors’ e-mail addresses, and searchable text.

The book’s first section (chapters 1–12) defines CER and describes issues related to CER from the social sciences’ perspective, while the second section (chapters 13–20) examines CER through the lenses of the epidemiologic and clinical sciences that underlie the health promotion and disease processes that are being prevented, diagnosed, and managed within the context of CER. The chapters are mostly well written and address their respective topics adequately, and the authors support their points with relevant literature. However, because each chapter is seemingly written independently, redundancy is present across chapters, presentation feels inconsistent, and flow is suboptimal from 1 chapter to the next.

The early chapters (chapters 1–7) are informative, yet simultaneously occasionally redundant and disjointed. Several topics, such as the Affordable Care Act, Patient Centered Outcomes Research Institute, and randomized controlled trials, are introduced multiple times. Chapter 2 is a comprehensive review of ethical frameworks and CER; however, chapter 3 also includes a section on ethical values and social norms. Furthermore, the presentation of information is inconsistent, because some authors include long, bulleted lists with minimal explanation of terms while others use extensive prose.

The middle chapters are one of the book’s main strengths. These chapters cover a broad range of important components of CER, such as a strong foundational discussion of how one should consider costs in CER and sources of data for CER studies. These are 2 particularly important and challenging components of CER, and the authors of these chapters share a thoughtful, balanced discussion on the relative benefits and risks of different approaches. For health care professionals with limited experience in health economics, medical decision making, and CER, these chapters and several others in the text are useful and possibly essential reading.

The later chapters explore the applications of CER in real-world scenarios that would likely interest a diverse range of health care professionals. Several important CER topics are discussed: the use of CER when comparing drug and medical devices, how patient input should be incorporated into CER studies, and how to apply new statistical methods to CER. These chapters have a notably strong bias toward the application of CER in the United States with some discussion of CER in other countries such as the United Kingdom, Australia, and Canada. A comprehensive chapter that specifically addresses the variation in importance and implementation of CER around the world would have been a welcome addition. The limitations of Comparative Effectiveness Research in Health Services can be improved in future editions. Most notably, typographic errors, unclear use of acronyms, and significant variation in formatting between chapters take away from the reading experience. Fortunately, these can be corrected in future editions, as can the book’s cohesiveness and flow to present CER more effectively to the reader.

While Comparative Effectiveness Research in Health Services reads more like individual essays placed together in 1 textbook, the book provides a comprehensive collection of topics that are relevant for students and professionals wishing to understand CER. Health care system changes for now and into the foreseeable future will require health care professionals to carefully balance medical decision making with an eye toward what is most effective for a given patient, what is most effective for a given population, and what the relative costs may be. Comparative Effectiveness Research in Health Services provides a solid foundation for learning a significant amount about one of the most important methodologies in health care decision making today.

Jonathan M. Tan, MD, MPHDepartment of Anesthesiology and Critical CarePerelman School of Medicine at the University of Pennsylvaniaand Children’s Hospital of PhiladelphiaPhiladelphia, Pennsylvania

Jack O. Wasey, BM BCh, MA, MSci, MScDepartment of Anesthesiology and Critical Care MedicineChildren’s Hospital of PhiladelphiaPhiladelphia, Pennsylvania

Allan F. Simpao, MD, MBIDepartment of Anesthesiology and Critical CarePerelman School of Medicine at the University of Pennsylvaniaand Children’s Hospital of PhiladelphiaPhiladelphia, Pennsylvaniasimpaoa@email.chop.edu

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