A new metric accurately assessed the total clinical value of personalized psychiatric treatment outcomes, according to results of a pilot study presented at the 2012 New Clinical Drug Evaluation Unit Meeting in Phoenix.
“If some method could be found to capture the totality of a treatment’s clinical impact on patients, it would significantly advance the ability of clinicians to recommend a specific treatment to a particular individual, considering all of the patient’s relevant facts,” the researchers wrote.
To devise that method, Ellen Frank, PhD, and colleagues from the University of Pittsburgh School of Medicine recruited an expert panel to compare 100 pairs of patients enrolled in a randomized controlled trial. Each pair was comprised of a patient assigned interpersonal psychotherapy and a patient assigned escitalopram (Lexapro, Forest Laboratories).
The panel, masked to participants’ treatment assignments, was instructed to select the patient with the preferred outcome while taking both benefits and harms of treatment into account. Based on the panel’s decisions, an “integrated preference score” (IPS) was derived so that the differences between any two patients’ scores would predict the clinicians’ preferences, according to the researchers.
The panel was then asked to rate another 100 pairs of patients. Using the IPS from the first group, the panel's actual preferences were found to have correlated highly (r=0.84) with the differences predicted by their initial IPS. The IPS was applied to all patients in the trial and was then used to compare the two treatments.
“The 95% confidence interval for the effect size comparing treatments indicated clinical equivalence of the treatments,” the investigators wrote.
Frank told Healio.com that she was surprised how easy the methods were to use.
“We should be focusing on how benefits and harms of treatments aggregate at the individual patient — not group — level,” Frank said. “We should be trying to develop profiles of patients most likely to have high benefit and low harm from each treatment we are interested in.”
Frank E. A pilot study of the integrated preference score (IPS) to assess harm-benefit balance in a depression RCT. Presented at: the 2012 NewClinical Drug Evaluation Unit Annual Meeting; May 29-June 1, 2012; Phoenix.
Disclosure: Dr. Frank reports no relevant financial disclosures.