Article type
Year
Abstract
Background: Some Medicaid programs in the United States are now using evidence-based strategies to manage appropriate use of outpatient prescription drugs. The Drug Effectiveness Review Project (DERP) is one example of a coordinated effort by a consortium of State Medicaid pharmacy programs to use evidence-based drug reviews to guide their prescription drug benefit decisions. Over the first three years of the project (DERP I), the consortium funded reviews of 28 drug classes and plan to fund reviews of another 8 topics between now and 2009 (DERP II). The ongoing value of the DERP reviews in policy-making depends largely on the supply of timely updates. In DERP I every drug class review was updated at an arbitrarily-chosen fixed frequency of every 6-12 months. Due to core funding constraints, however, there are limitations on the number of updates that can be produced during DERP II. In addition, the consortium now recognizes that some of the more slowly developing topics do not need updating at the frequency set out in DERP I. Therefore, the DERP II consortium was faced with developing and implementing a practical and efficient methodology for determining how to set priorities for which reviews to update. This innovative work could bring some clarity to an area of systematic review methodology that is currently lacking.
Objectives: To describe processes developed for the DERP II consortium to use in deciding which systematic reviews to update. To test associations between attributes of emergent evidence and decision to update and conduct exploratory analyses to identify potential decision rules for future updates.
Methods: Starting in November 2006, Oregon Evidence-based Practice Center (EPC) researchers began conducting preliminary systematic searches of electronic databases to identify new evidence that has emerged since the completion of previously conducted DERP reviews. We are using the same search strategies from the previous reviews, but are limiting these searches to Medline and to controlled clinical trials (CCT). We are also searching FDA and Health Canada websites to identify new drugs, safety alerts, and new or modified indications. We are producing brief reports of our preliminary update search findings for the DERP consortium to determine which DERP drug class reviews are in need of a full update. The preliminary update searching process will be repeated for all DERP reviews on at least an annual basis. We will abstract and present data from all preliminary update searches completed by September 2007. We will conduct logistic regression analyses to determine associations between decision to undertake a full update and the following attributes: (1) total number of new CCTs, (2) number of CCTs with head-to-head comparisons of one or more competing drugs in a class, (3) presence of new drugs, (4) presence of new or modified indications, (5) presence of significant new safety alerts. We will conduct further exploratory analyses using classification and regression tree (CART) methods to identify potential decision rules for future updates.
Results: The Oregon EPC has completed preliminary update searches for 19 previous DERP drug class reviews. Of those, so far 4 (21%) have been chosen for full updates. Among the 5 attributes, preliminary CART analyses only identified a total number of new CCTs above 21 as being predictive of a decision to update.
Conclusions: Preliminary update searches for an additional 8 DERP drug class reviews will be completed by October 2007. Analyses of data from all 27 preliminary scans will also be completed at that time.
Objectives: To describe processes developed for the DERP II consortium to use in deciding which systematic reviews to update. To test associations between attributes of emergent evidence and decision to update and conduct exploratory analyses to identify potential decision rules for future updates.
Methods: Starting in November 2006, Oregon Evidence-based Practice Center (EPC) researchers began conducting preliminary systematic searches of electronic databases to identify new evidence that has emerged since the completion of previously conducted DERP reviews. We are using the same search strategies from the previous reviews, but are limiting these searches to Medline and to controlled clinical trials (CCT). We are also searching FDA and Health Canada websites to identify new drugs, safety alerts, and new or modified indications. We are producing brief reports of our preliminary update search findings for the DERP consortium to determine which DERP drug class reviews are in need of a full update. The preliminary update searching process will be repeated for all DERP reviews on at least an annual basis. We will abstract and present data from all preliminary update searches completed by September 2007. We will conduct logistic regression analyses to determine associations between decision to undertake a full update and the following attributes: (1) total number of new CCTs, (2) number of CCTs with head-to-head comparisons of one or more competing drugs in a class, (3) presence of new drugs, (4) presence of new or modified indications, (5) presence of significant new safety alerts. We will conduct further exploratory analyses using classification and regression tree (CART) methods to identify potential decision rules for future updates.
Results: The Oregon EPC has completed preliminary update searches for 19 previous DERP drug class reviews. Of those, so far 4 (21%) have been chosen for full updates. Among the 5 attributes, preliminary CART analyses only identified a total number of new CCTs above 21 as being predictive of a decision to update.
Conclusions: Preliminary update searches for an additional 8 DERP drug class reviews will be completed by October 2007. Analyses of data from all 27 preliminary scans will also be completed at that time.