Using N-of-1 Trials to Improve Patient Management and Save Costs

• Published in: Journal of general internal medicine : JGIM 2010-09, Vol.25 (9), p.906-913
• Main Authors: Scuffham, Paul A., Nikles, Jane, Mitchell, Geoffrey K., Yelland, Michael J., Vine, Norma, Poulos, Christopher J., Pillans, Peter I., Bashford, Guy, del Mar, Chris, Schluter, Philip J., Glasziou, Paul
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Attention Deficit Disorder with Hyperactivity - drug therapy; Australia; Biological and medical sciences; Child; Child, Preschool; Chronic Disease - drug therapy; Chronic Disease - economics; Clinical outcomes; Clinical trials; Cost analysis; Cost-Benefit Analysis; Cross-Over Studies; Double-Blind Method; Drug therapy; Evidence-Based Medicine - economics; Female; General aspects; Humans; Internal Medicine; Male; Medical sciences; Medication Adherence; Medicine; Medicine & Public Health; Middle Aged; Miscellaneous; Neuralgia - drug therapy; Original Research; Osteoarthritis - drug therapy; Precision Medicine - economics; Public health. Hygiene; Public health. Hygiene-occupational medicine; Research Design; Treatment Outcome; Young Adult
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-010-1352-7

ABSTRACT BACKGROUND N-of-1 trials test treatment effectiveness within an individual patient. OBJECTIVE To assess (i) the impact of three different N-of-1 trials on both clinical and economic outcomes over 12 months and (ii) whether the use of N-of-1 trials to target patients’ access to high-cost drugs might be cost-effective in Australia. DESIGN Descriptive study of management change, persistence, and costs summarizing three N-of-1 trials. PARTICIPANTS Volunteer patients with osteoarthritis, chronic neuropathic pain or ADHD whose optimal choice of treatment was uncertain. INTERVENTIONS Double-blind cyclical alternative medications for the three conditions. MEASURES Detailed resource use, treatment and health outcomes (response) data collected by postal and telephone surveys immediately before and after the trial and at 3, 6 and 12 months. Estimated costs to the Australian healthcare system for the pre-trial vs. 12 months post-trial. RESULTS Participants persisting with the joint patient-doctor decision 12 months after trial completion were 32% for osteoarthritis, 45% for chronic neuropathic pain and 70% for the ADHD trials. Cost-offsets were obtained from reduced usage of non-optimal drugs, and reduced medical consultations. Drug costs increased for the chronic neuropathic pain and ADHD trials due to many patients being on either low-cost or no pharmaceuticals before the trial. CONCLUSIONS N-of-1 trials are an effective method to identify optimal treatment in patients in whom disease management is uncertain. Using this evidence-based approach, patients and doctors tend to persist with optimal treatment resulting in cost-savings. N-of-1 trials are clinically acceptable and may be an effective way of rationally prescribing some expensive long-term medicines.