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Comparative Effectiveness Research and Personalized Medicine

Catalyzing or Colliding?

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  • Comparative Effectiveness and Personalized Medicine
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Abstract

Comparative effectiveness research (CER) is generating intense attention as interest grows in finding new and better drug technology assessment processes. The federal government is supporting the expansion of CER through funding made available in the American Recovery and Reinvestment Act of 2009 (ARRA) and by establishing the Patient-Centered Outcomes Research Institute through the Patient Protection and Affordable Care Act of 2010. At the same time, personalized medicine is generating debate about its place in clinical medicine, and so, naturally, how CER can or cannot play a role in personalized medicine is part of these debates. At the heart of the debate around the role of CER in personalized medicine is the nature of personalized medicine and how it fits within contemporary clinical research concepts. We maintain in this article that CER can serve to catalyze personalized medicine, but we recognize that, for this to happen, researchers will need to embrace new data sources and new analytic approaches. We also recognize that drug technology assessment processes will have to undergo necessary adaptations to accommodate CER as configured for personalized medicine, and that clinicians will need to be educated appropriately and provided access to decision-support systems through health information technology to use the information coming from this research.

To illustrate our argument, we describe two ongoing CER studies funded and managed in the private sector evaluating personalized medicine interventions that have important clinical and financial implications. One of the studies investigates the clinical and financial effects of pharmacogenomic testing for warfarin as prescribed in conditions of typical practice settings. The other study is also set in community practice settings and compares cardiovascular outcomes of patients receiving clopidogrel who are extensive metabolizer phenotypes for the cytochrome P450 2C19 hepatic isoenzyme with all patients receiving prasugrel.

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Acknowledgements

The authors thank William Dreitlein, PharmD, BCPS; Helen Kourlas, PharmD, BCPS; and Eric Stanek, PharmD, for their research assistance and input, and Elle Hajjar for her assistance with the manuscript and graphics.

No sources of funding were used to assist in the preparation of this article. The authors have no conflicts of interest that are directly relevant to the content of this article.

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Authors and Affiliations

  1. Department of Medical and Analytical Affairs, Medco Health Solutions, Inc., 100 Parsons Pond Drive, Franklin Lakes, New Jersey, 07417, USA

    Robert S. Epstein & J. Russell Teagarden (Vice President, Clinical Practices & Therapeutics)

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  1. Robert S. Epstein
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  2. J. Russell Teagarden
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Correspondence to J. Russell Teagarden.

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Epstein, R.S., Teagarden, J.R. Comparative Effectiveness Research and Personalized Medicine. Pharmacoeconomics 28, 905–913 (2010). https://doi.org/10.2165/11535830-000000000-00000

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