Composite scores in comparative effectiveness research: counterbalancing parsimony and dimensionality in patient-reported outcomes.

Research paper by Carolyn E CE Schwartz, Donald L DL Patrick

Indexed on: 03 Oct '14Published on: 03 Oct '14Published in: Journal of comparative effectiveness research


When planning a comparative effectiveness study comparing disease-modifying treatments, competing demands influence choice of outcomes. Current practice emphasizes parsimony, although understanding multidimensional treatment impact can help to personalize medical decision-making. We discuss both sides of this 'tug of war'. We discuss the assumptions, advantages and drawbacks of composite scores and multidimensional outcomes. We describe possible solutions to the multiple comparison problem, including conceptual hierarchy distinctions, statistical approaches, 'real-world' benchmarks of effectiveness and subgroup analysis. We conclude that comparative effectiveness research should consider multiple outcome dimensions and compare different approaches that fit the individual context of study objectives.