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. 1995 Oct 21;311(7012):1056–1060. doi: 10.1136/bmj.311.7012.1056

Evidence based purchasing: understanding results of clinical trials and systematic reviews.

T Fahey 1, S Griffiths 1, T J Peters 1
PMCID: PMC2551363  PMID: 7580661

Abstract

OBJECTIVE--To assess whether the way in which the results of a randomised controlled trial and a systematic review are presented influences health policy decisions. DESIGN--A postal questionnaire to all members of a health authority within one regional health authority. SETTING--Anglia and Oxford regional health authorities. SUBJECTS--182 executive and non-executive members of 13 health authorities, family health services authorities, or health commissions. MAIN OUTCOME MEASURES--The average score from all health authority members in terms of their willingness to fund a mammography programme or cardiac rehabilitation programme according to four different ways of presenting the same results of research evidence--namely, as a relative risk reduction, absolute risk reduction, proportion of event free patients, or as the number of patients needed to be treated to prevent an adverse event. RESULTS--The willingness to fund either programme was significantly influenced by the way in which data were presented. Results of both programmes when expressed as relative risk reductions produced significantly higher scores when compared with other methods (P < 0.05). The difference was more extreme for mammography, for which the outcome condition is rarer. CONCLUSIONS--The method of reporting trial results has a considerable influence on the health policy decisions made by health authority members.

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Selected References

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  1. Bobbio M., Demichelis B., Giustetto G. Completeness of reporting trial results: effect on physicians' willingness to prescribe. Lancet. 1994 May 14;343(8907):1209–1211. doi: 10.1016/s0140-6736(94)92407-4. [DOI] [PubMed] [Google Scholar]
  2. Bucher H. C., Weinbacher M., Gyr K. Influence of method of reporting study results on decision of physicians to prescribe drugs to lower cholesterol concentration. BMJ. 1994 Sep 24;309(6957):761–764. doi: 10.1136/bmj.309.6957.761. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Cook R. J., Sackett D. L. The number needed to treat: a clinically useful measure of treatment effect. BMJ. 1995 Feb 18;310(6977):452–454. doi: 10.1136/bmj.310.6977.452. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Forrow L., Taylor W. C., Arnold R. M. Absolutely relative: how research results are summarized can affect treatment decisions. Am J Med. 1992 Feb;92(2):121–124. doi: 10.1016/0002-9343(92)90100-p. [DOI] [PubMed] [Google Scholar]
  5. Guyatt G. H., Sackett D. L., Cook D. J. Users' guides to the medical literature. II. How to use an article about therapy or prevention. B. What were the results and will they help me in caring for my patients? Evidence-Based Medicine Working Group. JAMA. 1994 Jan 5;271(1):59–63. doi: 10.1001/jama.271.1.59. [DOI] [PubMed] [Google Scholar]
  6. Ham C., Hunter D. J., Robinson R. Evidence based policymaking. BMJ. 1995 Jan 14;310(6972):71–72. doi: 10.1136/bmj.310.6972.71. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hayward J. Purchasing clinically effective care. BMJ. 1994 Oct 1;309(6958):823–824. doi: 10.1136/bmj.309.6958.823. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Hux J. E., Levinton C. M., Naylor C. D. Prescribing propensity: influence of life-expectancy gains and drug costs. J Gen Intern Med. 1994 Apr;9(4):195–201. doi: 10.1007/BF02600123. [DOI] [PubMed] [Google Scholar]
  9. Hux J. E., Naylor C. D. Effect of coronary artery bypass graft surgery on survival. Lancet. 1994 Oct 29;344(8931):1223–1224. [PubMed] [Google Scholar]
  10. Laupacis A., Sackett D. L., Roberts R. S. An assessment of clinically useful measures of the consequences of treatment. N Engl J Med. 1988 Jun 30;318(26):1728–1733. doi: 10.1056/NEJM198806303182605. [DOI] [PubMed] [Google Scholar]
  11. Laupacis A., Sackett D. L., Roberts R. S. Therapeutic priorities of Canadian internists. CMAJ. 1990 Feb 15;142(4):329–333. [PMC free article] [PubMed] [Google Scholar]
  12. Malenka D. J., Baron J. A., Johansen S., Wahrenberger J. W., Ross J. M. The framing effect of relative and absolute risk. J Gen Intern Med. 1993 Oct;8(10):543–548. doi: 10.1007/BF02599636. [DOI] [PubMed] [Google Scholar]
  13. Manolio T. A., Furberg C. D. Age as a predictor of outcome: what role does it play? Am J Med. 1992 Jan;92(1):1–6. doi: 10.1016/0002-9343(92)90007-x. [DOI] [PubMed] [Google Scholar]
  14. Naylor C. D., Chen E., Strauss B. Measured enthusiasm: does the method of reporting trial results alter perceptions of therapeutic effectiveness? Ann Intern Med. 1992 Dec 1;117(11):916–921. doi: 10.7326/0003-4819-117-11-916. [DOI] [PubMed] [Google Scholar]
  15. Oldridge N. B., Guyatt G. H., Fischer M. E., Rimm A. A. Cardiac rehabilitation after myocardial infarction. Combined experience of randomized clinical trials. JAMA. 1988 Aug 19;260(7):945–950. [PubMed] [Google Scholar]
  16. Sackett D. L., Cook R. J. Understanding clinical trials. BMJ. 1994 Sep 24;309(6957):755–756. doi: 10.1136/bmj.309.6957.755. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Tabár L., Fagerberg C. J., Gad A., Baldetorp L., Holmberg L. H., Gröntoft O., Ljungquist U., Lundström B., Månson J. C., Eklund G. Reduction in mortality from breast cancer after mass screening with mammography. Randomised trial from the Breast Cancer Screening Working Group of the Swedish National Board of Health and Welfare. Lancet. 1985 Apr 13;1(8433):829–832. doi: 10.1016/s0140-6736(85)92204-4. [DOI] [PubMed] [Google Scholar]
  18. Yusuf S., Zucker D., Peduzzi P., Fisher L. D., Takaro T., Kennedy J. W., Davis K., Killip T., Passamani E., Norris R. Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet. 1994 Aug 27;344(8922):563–570. doi: 10.1016/s0140-6736(94)91963-1. [DOI] [PubMed] [Google Scholar]

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