title: Heterogeneity in action: the role of passive personalization in comparative effectiveness research.
abstract: Despite the goal of comparative effectiveness research (CER) to inform patient-centered care, most studies fail to account for the patient-centeredness of care that already exist in practice, which we denote as passive personalization (PP). Because CER studies describe the average effectiveness of treatments rather than heterogeneity in how individual patients respond to therapies, clinical or coverage policies that respond to CER results may undermine PP in clinical practice and generate worse outcomes. We study this phenomenon empirically in the context of use of antipsychotic drugs in Medicaid patients with schizophrenia using novel instrumental variable methods. We find strong support for PP in clinical practice and demonstrate that the average effects from a CER study cannot be replicated in practice because of the presence of PP. In contrast, providing physicians with evidence to further personalize treatment can produce significant benefits.
authors.affiliation: Department of Health Services, University of Washington, Seattle and the National Bureau of Economic Research, Cambridge MA, Seattle, WA, USA.
authors.forename: Anirban
authors.initials: A
authors.lastname: Basu
authors.forename: Anupam B
authors.initials: AB
authors.lastname: Jena
authors.forename: Dana P
authors.initials: DP
authors.lastname: Goldman
authors.forename: Tomas J
authors.initials: TJ
authors.lastname: Philipson
authors.forename: Robert
authors.initials: R
authors.lastname: Dubois
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D057186:Comparative Effectiveness Research / Q000706:statistics & numerical data; D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017059:Models, Econometric; D057285:Precision Medicine / Q000523:psychology / Q000592:standards / Q000706:statistics & numerical data*; D012559:Schizophrenia / Q000188:drug therapy; D016896:Treatment Outcome; D014481:United States
chemical_list: D014150:Antipsychotic Agents
keywords: antipsychotic drugs; comparative effectiveness; heterogeneity; passive personalization; schizophrenia