Real-World Evidence: Useful in the Real World of US Payer Decision Making? How? When? And What Studies?

Daniel C Malone, Mary Brown, Jason T. Hurwitz, Loretta Peters, Jennifer S. Graff

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives: To examine how real-world evidence (RWE) is currently perceived and used in managed care environments, especially to inform pharmacy and therapeutic (P&T) committee decisions, to assess which study factors (e.g., data, design, and funding source) contribute to RWE utility in decisions, and to identify barriers to consideration of RWE studies in P&T decision making. Methods: We conducted focus groups/telephone-based interviews and surveys to understand perceptions of RWE and assess awareness, quality, and relevance of two high-profile examples of published RWE studies. A purposive sample comprised 4 physicians, 15 pharmacists, and 1 researcher representing 18 US health plans and health system organizations. Results: Participants reported that RWE was generally used, or useful, to inform safety monitoring, utilization management, and cost analysis, but less so to guide P&T decisions. Participants were not aware of the two sample RWE studies but considered both studies to be valuable. Relevant research questions and outcomes, transparent methods, study quality, and timely results contribute to the utility of published RWE. Perceived organizational barriers to the use of published RWE included lack of skill, training, and timely study results. Conclusions: Payers recognize the value of RWE, but use of such studies to inform P&T decisions varies from organization to organization and is limited. Relevance to payers, timeliness, and transparent methods were key concerns with RWE. Participants recognized the need for continuing education on evaluating and using RWE to better understand the study methods, findings, and applicability to their organizations.

Original languageEnglish (US)
JournalValue in Health
DOIs
StateAccepted/In press - Jan 1 2017

Fingerprint

Decision Making
Organizations
Health Systems Plans
Continuing Education
Managed Care Programs
Focus Groups
Pharmacists
Research Personnel
Outcome Assessment (Health Care)
Interviews
Physicians
Safety
Costs and Cost Analysis
Health
Therapeutics

Keywords

  • Health care decision making
  • Observational research
  • Payer
  • Real-world evidence

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Real-World Evidence : Useful in the Real World of US Payer Decision Making? How? When? And What Studies? / Malone, Daniel C; Brown, Mary; Hurwitz, Jason T.; Peters, Loretta; Graff, Jennifer S.

In: Value in Health, 01.01.2017.

Research output: Contribution to journalArticle

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