Labelle Lectureship
Roberta Labelle was one of the Centre's founding members. Her death in 1991 was unexpected and occurred when broad recognition for her research in health economics was just starting to emerge. In memory of Roberta, CHEPA and the Department of Clinical Epidemiology and Biostatistics collaborated on establishing the Annual Labelle Lectureship Series. In October each year a health services researcher with emerging recognition and an inter-disciplinary approach to research, gives a general interest lecture on a topic in the broadly defined areas of health economics and/or health policy. The Labelle Lecturer is also available for consultations with individuals in and outside McMaster University during the period of his/her visit. An endowment was established to assure the ongoing funding of the Lectureship.
2009: Anirban Basu, MS, PhD
Assistant Professor, Department of Medicine, University of Chicago
Faculty Research Fellow, National Bureau of Economic Research
"Comparative Effectiveness Research: Another Emperor With no Clothes?"
Wednesday, October 7, 2009, HSC-1A1, 3 p.m. to 4:30 p.m.
The need to re-examine how cost effectiveness research (CER) can help provide improved health care while maintaining physician and patient autonomy in treatment choices was explored at the 18th Annual Labelle Lecture.
Anirban Basu, assistant professor in the Department of Medicine at the University of Chicago, shared the results of a case study on the use of antipsychotic drugs and the prevalence of diabetes in patients with schizophrenia, to illustrate the impact of CER on prescription drug use, and highlight the potential pitfalls of traditional methods for conducting this type of research.
CER is emerging as a key method for informing decisions about health care reform in the United States. CER promotes head-to-head research to determine which drugs, devices and procedures are most effective and carry the lowest risk. Although controversies remain regarding the inclusion of costs in such research, a renewed interest in comparative effectiveness methods and applications has the potential to deliver timely and crucial information to physicians and improve efficiency and quality of care. While some global health care systems rely on CER for policymaking, the American system wants to avoid any formal rationing mechanism, yet contain costs.
Basu illustrated how CER identified that specific antipsychotic drugs produced a greater proportion of metabolic side effects, such as weight gain, leading to a higher incidence of diabetes among people taking the drugs. That information helped change prescribing practices, saving the U.S. about $850 million annually.
Basu said that while timely CER can be valuable in terms of reduced side effects and improved efficacy, traditional CER relies on average results, and fails to answer questions at a more individualized level regarding patient behaviours and outcomes. The research on averages has the potential to mislead physicians who have to deal with heterogeneity, and induce inefficient coverage policies.
“The biological heterogeneity in diseases is often so great that proposing one vs. another in an all-or-none situation could have enormous consequences for the welfare of the patients,” he said.
He argued in favour of more individualized CER, which requires a paradigm shift in research design and methods, and would have implications for patient welfare, market share and prices, and incentives for innovation.
To view the slides from the presentation, click here.
Biosketch:
Anirban Basu has a MS in Biostatistics and PhD in Public Policy. His research interests lie in revealing heterogeneity in clinical and economic outcomes in order to establish the value of individualized care, and translating such information for public policy using innovative methods in comparative effectiveness and cost-effectiveness research. He has extensive experience in modelling health expenditure data, addressing selection biases in observational data and working on the theoretical and empirical foundations in cost-effectiveness analyses and value of information analyses in the context of prostate cancer and schizophrenia.
Discussant: Stirling Bryan, Director, Centre for Clinical Epidemiology & Evaluation, UBC
For a list of previous speakers at the Labelle Lecture, click here.