Therapeutics, Evidence and Decision-Making

by Michael Rawlins

Overview

This book is intended to help decision-makers use, assess and appraise the evidence that underpins decisions about the use of therapeutic interventions. It will inform decision-makers about the nature of evidence, the strengths and weaknesses of the available approaches, and how these can be most effectively distilled for the purpose of reaching reliable conclusions. It aims to encourage decision-makers to base their judgements about the use of therapeutic interventions on an informed appraisal of the totality of the evidence base. Is it reliable? Is it generalisable beyond the context of the environment in which the primary research has been conducted? Do the intervention's benefits outweigh its harms? Is it cost effective as well as clinically effective? Is it, indeed, fit-for-purpose? Ultimately, good judgement is at the heart of decision-making in therapeutics.

An invaluable text for all physicians, pharmacists, nurses, health commissioners and purchasers and indeed anyone having to make decisions concerning evidence-based therapeutics.

Product Details

ISBN-13:	9781853159473
Publisher:	Taylor & Francis
Publication date:	07/29/2011
Pages:	256
Product dimensions:	6.10(w) x 9.10(h) x 0.50(d)

About the Author

Professor Sir Michael Rawlins MD FRCP(Lond) FRCP(Edin) FFPM FMedSci, National Institute for Clinical Excellence, London, U

Table of Contents

Foreword ix

Preface xi

Acknowledgements xiii

Section 1 Introduction 1

1.1 The nature of evidence 3

1.2 Probability 8

1.3 Clinical endpoints of benefits and harms 15

1.4 Statistical expressions of benefit and harm 22

1.5 Bias and confounding 32

1.6 Systematic reviews 43

Section 2 Randomized controlled trials 61

2.1 General principles 63

2.2 Stopping rules 84

2.3 Analysis of subgroups 91

2.4 Safety 96

2.5 Generalizability 103

Section 3 Observational studies 111

3.1 General overview 113

3.2 Historical controlled trials 119

3.3 Concurrent cohort studies 127

3.4 Case-control designs 134

3.5 Databases 142

3.6 Case reports 143

Section 4 Qualitative research 155

4.1 Approaches and methods 157

4.2 Uses in the evaluation of therapeutic interventions 163

Section 5 Economic evaluation 171

5.1 General principles 173

5.2 Cost-effectiveness, cost-utility and cost-minimization analyses 187

5.3 Cost-consequences analysis 196

Section 6 Decision-making 199

6.1 For individuals 201

6.2 For populations 208

Glossary 221

Index 223