HIEBP - when evidence is not implemented

Question 1

what is efficacy

Answer 1

• the power or ability to produce an effect
• best tested in medicine with a randomized controlled trial

Question 2

what is effectiveness

Answer 2

• the degree to which something is successful in producing a desired
• best tested in medicine with a ‘real’ world trial

Question 3

What is the efficacy-effectiveness gap?

Answer 3

The efficacy-effectiveness gap describes the differences in outcomes between patients treated in RCTs and those treated in the ‘real world’

Question 4

strengths of RCTs

Answer 4

• Accurate unbiased measurement of treatment effect
• High degree of internal validity
• Strict eligibility criteria - homogenous study population
• Accurate measurement of treatment effect
• Reduced inter-patient variability

Question 5

what are the limitations of RCTs

Answer 5

• Suboptimal representation of patients treated in the real world setting
• Most marked among patients with advanced age or greater comorbidities

Question 6

What is an RCT?

Answer 6

experiment to reduce bias when testing treatment efficacy

random allocation of subjects to two or more groups

treat them differently, compare the response
the experimental group—receives the intervention, eg a drug

the control group—receives an alternative perhaps a placebo

the groups are monitored to determine the efficacy of the experiment

Question 7

How does NICE decide on whether to support a new drug or device?

Answer 7

NICE recommends the NHS pays for interventions generating 1 QALY if the intervention costs less than £30,000/QALY achieved

(One quality-adjusted life year(QALY) is equal to 1 year of life in perfect health)