Determining the primary endpoints for diagnostic test accuracy reviews of substance use disorders

Tags: Poster
Klimas J1, Dormuth C2, Wood E3
1University of British Columbia, British Columbia Centre on Substance Use, 2Therapeutics Initiative, University of British Columbia, 3University of British Columbia, BC Centre on Substance Use

Background: Diagnostic test accuracy reviews increasingly are being used in substance use research, yet the majority of the studies considered in these reviews do not account appropriately for the primary endpoints of interest. Recently, the DSM-5 criteria have been largely criticized as poorly able to properly distinguish those with problematic use from those with substance use disorders.

Objective: We review the main implications of adopting alternate primary endpoints in diagnostic test accuracy reviews of substance use disorders and highlight a practical application of appropriate analytical techniques.

Methods: The application of literature-derived primary endpoints is demonstrated through the use of empirical data from two substance use diagnostic test accuracy reviews. Primary endpoints were derived from literature in a review of alcohol-withdrawal patient assessment (JAMA 320(8):825-33), and patient risks of developing prescription opioid use disorders when initiating opioid analgesics for pain among opioid naïve patients (Figure 1, JAMA Network Open. 2(5):e193365). Primary endpoint options in existing substance use studies were evaluated. This evaluation included surveys of the literature for endpoints and measurement approaches, followed by assessment of endpoint choices against diagnostic test accuracy issues, population characteristics, tests of sensitivity and specificity. The advantages of this practical approach are discussed.

Conclusions: Inappropriate definitions of primary endpoints in diagnostic test accuracy studies can lead to the presentation of inaccurate results and hence potentially misleading conclusions. We have demonstrated that adjustment for literature-derived endpoints, as opposed to using the criticized DSM-5 criteria, can be useful in these studies and we encourage more judicious use of the established diagnostic categories to enhance accuracy of reviews and meta-analyses.

Patient/ healthcare consumer involvement: British Columbia Centre on Substance Use Network of Family Members and Caregivers reviewed the meta-analyses and facilitated findings’ dissemination. It is comprised of families who are affected by and want to change the existing substance use system, including representatives from various support and advocacy groups.