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More Comparative Studies Needed to Guide Physicians

Study finds less than a third of published clinical studies make real-world treatment comparisons

TUESDAY, March 9 (HealthDay News) -- Comparative effectiveness (CE) studies currently are underutilized and should be increased to better guide physicians in the effective everyday use of current therapies, according to a review in the March 10 issue of the Journal of the American Medical Association.

Michael Hochman, M.D., and a colleague from Harvard Medical School in Boston reviewed the six leading general and internal medicine journals during 2008 to 2009 and identified 328 randomized trials, observational studies, and meta-analyses on medications, including 104 (32 percent) CE studies comparing current active treatments, and 224 (68 percent) non-CE studies of novel treatments or with an inactive control design. The reviewers characterized and identified funding of the CE studies and compared them to the non-CE studies.

The researchers found that, among the CE studies, 43 percent compared medications, 31 percent compared varied pharmacologic strategies, 15 percent compared different dosing schedules for a medication, and 11 percent compared medications with non-pharmacologic therapies. Nineteen percent of the CE studies assessed safety and just 2 percent included analyses of cost-effectiveness. The CE studies were less likely to be commercially funded than non-CE studies (13 versus 45 percent), and randomized trials with an active-comparator were less likely to report positive results than trials with inactive controls (44 versus 66 percent).

"In particular, our findings suggest government and noncommercial support should be increased for studies involving non-pharmacologic therapies, for studies comparing different therapeutic strategies, and for studies focusing on the comparative safety and cost of different therapies," the authors write.

The author of an accompanying commentary reported receiving research support in the past five years from a pharmaceutical company unrelated to this subject.

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