1	Translating Data into Health Policy
2	"This conference has been about..." This conference has been about strategies to develop evidence Maximizing the quality of evidence given limited research dollars. Cost-effective input into evidence-based policy decisions
3	"This conference has been about..." This conference has been about strategies to develop evidence Maximizing the quality of evidence given limited research dollars. Cost-effective input into policy decisions This session is about the quality of public decision making.
4	How much benefit is good enough? Described CMS coverage policymaking Population-level expected outcome decision making Efficacy is the decision criterion, not cost. Cost enters with price setting How would decisions change if CE was a criterion? How much benefit is enough? At least as much as previously covered item Do coverage decisions consistently mirror the evidence?
5	Opportunity costs and societal trade-offs Advice about how to allocate research funding Argues for population health perspective in setting funding priorities Should use C-E as a measure of value when setting priorities. Who decides our national research funding priorities now? How?
6	Third party payer perspective Get revenue from insurers and employers. A prudent buyer of “medically necessary services.” Tries to control volume, not unit price. Strives for consistency by using services of proven effectiveness. Frustrated by appeals to use unproven, costly therapy. Will costly new technology be judged only on efficacy or on cost per QALY?
7	"The common theme" The common theme: decisions about policies to allocate scarce resources Investment in research Investment in clinical services A common sub-theme: taking a population perspective Frustrated by appeals to make exceptions
8	"This conference has been about..." This conference has been about strategies to develop evidence to support decision making about policy This session is about the quality of decision making about policy. What values drive these decisions? Do our policy decisions consistently reflect these values?
9	"We can certainly do better..." We can certainly do better in our public policy decision-making. Inconsistency in applying principles Population perspective Evidence-based Focus on value (C-E) Consistency is good. Can we also allow for reasonable variation in practice? Can we develop a consistent approach to allowing some flexibility?
10	Consistency “A foolish consistency is the hobgoblin of little minds.” Ralph Waldo Emerson (as quoted in Next Stop Wonderland)
11	Advantages to being consistent Consistency: Rules to evaluate evidence Rules for using evidence to make a decision Advantages To manufacturers (how to plan) To funding agencies (what research to fund) To researchers (which research to do) Doctors and patients (meaning of a recommendation)
12	"Consistency of approach" Consistency of approach: We have good decision processes but we’re not consistent in applying them. USPSTF as a model of consistency and transparency
13	Wording of Recommendations A - Strongly recommend good evidence, benefits substantially outweigh harms B - Recommend at least fair evidence, benefits outweigh harms C - USPSTF makes no recommendation fair to good evidence, benefits and harms closely balanced D - Recommend against routine use ineffective or harms outweigh potential benefits
14	I - Insufficient Evidence to Recommend For or Against Lack of evidence on clinical outcomes Poor quality of existing studies Good quality studies with conflicting results Confidence interval includes clinically important benefits
15	U.S. Preventive Services Task Force Over-all Rating of Evidence Good Fair Poor
16	USPSTF Rating System “Good” Consistent results Well-designed, well conducted Representative populations Directly assesses effects on health outcomes
17	USPSTF Rating System “Fair” Evidence adequate to determine effects on health outcomes but limited by: Number, quality, or consistency of studies Generalizability to routine practice Indirect character of the effect on health outcomes
18	USPSTF Rating System “Poor” Evidence is insufficient to assess effects on health outcomes because Limited number studies Limited power of studies (wide 95% CI àinconclusive results) Important flaws in design or conduct Gaps in the chain of evidence Lack of information on health outcomes
19	"A problem" A problem: the imposition of different value systems on the decision process. Politicians, profit, and patients (the 3 Ps) Will better quality data lead to better quality decision making? Precise, unbiased estimates of health effects based on many studies Will better data lead to consistency in policymaking? Will it trump the 3 Ps?
20	"We can certainly do better..." We can certainly do better in our public policy decision-making. Be more consistent in applying principles of good decision making. Learning to allow for reasonable variation in practice.