1st Edition

Therapeutics, Evidence and Decision-Making

By Michael Rawlins Copyright 2011

    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.

    Introduction
    The nature of evidence
    Probability
    Clinical endpoints of benefits and harms
    Statistical expressions of benefit and harm
    Bias and confounding
    Systematic reviews

    Randomized controlled trials
    General principles
    Stopping rules
    Analysis of subgroups
    Safety
    Generalizability

    Observational studies
    General overview
    Historical controlled trials
    Concurrent cohort studies
    Case-control designs
    Databases
    Case reports

    Qualitative research
    Approaches and methods
    Uses in the evaluation of therapeutic interventions

    Economic evaluation
    General principles
    Cost-effectiveness, cost-utility and cost-minimization analyses
    Cost-consequences analysis

    Decision-making
    For individuals
    For populations

    Biography

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

    "