Using N-of-1 trials to improve patient management and save costs

Authors

P A. Scuffham, Griffith University
J Nikles, University of Queensland
G K. Mitchell, University of Queensland
M J. Yelland, Griffith University
N Vine, Australian Red Cross Blood Service
C. Poulos, University of WollongongFollow
P I. Pillans, Princess Alexandra Hospital
Guy M. Bashford, University of WollongongFollow
C del Mar, Bond University
P J. Schluter, Auckland University of Technology
P Glasziou, Oxford University

RIS ID

34938

Publication Details

P. Scuffham, J. Nikles, G. Mitchell, M. Yelland, N. Vine, C. J. Poulos, P. Pillans, G. Bashford, C. del Mar, P. Schluter & P. Glasziou, "Using n-of-1 trials to improve patient management and save costs", Journal of General Internal Medicine 25 9 (2010) 906-913.

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.