Report

Teaser, summary, work performed and final results

Periodic Reporting for period 1 - COMPAR-EU (Comparing effectiveness of self-management interventions in 4 high priority chronic diseases in Europe)

Teaser

COMPAR-EU aims to identify, compare, and rank the most effective and cost-effective self-management interventions (SMIs) for adults in Europe with four high-priority chronic conditions: type 2 diabetes (T2DM), obesity, chronic obstructive pulmonary disease (COPD), and heart...

Summary

COMPAR-EU aims to identify, compare, and rank the most effective and cost-effective self-management interventions (SMIs) for adults in Europe with four high-priority chronic conditions: type 2 diabetes (T2DM), obesity, chronic obstructive pulmonary disease (COPD), and heart failure.
We will apply network meta-analysis, an extension of meta-analysis methodology that allows multiple (rather than pairwise) comparisons of intervention effectiveness, to randomised controlled trials (RCTs). This centralised analysis of several thousand RCTs will help overcoming current problems associated with the dispersion and duplication of evidence.
The objectives of COMPAR-EU are:
To identify, compare, and rank the most effective and cost-effective self-management interventions (including preventive and management domains) in Europe for adults living with four chronic diseases.
Specific objectives
• To validate a taxonomy of SMIs
• To identify and prioritise SMI outcomes from patients´ perspectives
• To synthesise existing evidence on SMIs from RCTs
• To compare the relative effectiveness of SMIs through systematic review and NMA methodology
• To model the impact of SMIs from the perspective of cost-effectiveness
• To analyse contextual and implementation factors to improve the implementability of SMIs
• To develop, including piloting, decision-making tools to facilitate and disseminate the use of the most effective SMIs to key end users through the COMPAR-EU technology information platform
• To conduct a comprehensive dissemination, communication, and exploitation plan to maximise the impact of the project

COMPAR-EU aims to facilitate informed decision-making and to support implementation of best practices in different healthcare contexts through an interactive platform featuring decision-making tools and other end products tailored to the needs of end users (policymakers, guideline developers and researchers, healthcare professionals, patients, and industry).

Work performed

COMPAR-EU was launched in January 2018 and up to now it has been focused on the preparatory work for the comparative analysis that will start in autumn 2019. There are two important highlights in the results reached in this period
• Externally validated taxonomy: we carried out a review of the literature on taxonomies related to self-management, which were the base to develop the COMPAR-EU taxonomy on SMIs. The taxonomy was validated in a two-round Delphi in which 26 international experts participated. The taxonomy is composed of 132 components, classified in four domains (intervention characteristics, expected patient (or carer) self-management behaviours, type of outcomes to measure self-management interventions and target population characteristics). The taxonomy is guiding part of the review of existing RCTs.
• Core Outcome Sets (COS) for each disease: we prepared an initial catalogue of outcomes based on previous EU projects and complemented with an overview of reviews of patient preferences. This catalogue of outcomes was prioritized by patients and patient representatives in two rounds of an online Delphi survey. The results of the Delphi were combined with those of the overview on patients’ preferences. A consensus meeting was held with 19 patients and patient representatives, 20 healthcare professionals and researchers, each representing one of the four disease-areas. The final COS for each condition includes 16 outcomes for COPD, 16 for Heart Failure, 13 for T2DM and 15 for Obesity. The COS are guiding the selection of outcomes to be analysed in our project.
The project has also advanced in the literature review, completing the phases of search and design of a tailored made interactive extraction form. On June 2019 the project was in the process of reviewing the T2DM RCT’s that will be used in the analysis.

Final results

The COMPAR-EU project will go beyond the state-of-the art in four key areas:
• We have developed COS with a strong involvement of patients, clinicians and decision makers, so selected outcomes are relevant to those living with the targeted condition.
• We will integrate existing disperse evidence on SMIs in the four chronic conditions based on a comprehensive taxonomy and rank them based on effectiveness and cost-effectiveness, helping stakeholders to make informed decisions.
• We will address differences in the effectiveness of SMIs for groups that frequently face health inequities, including analysis of subgroups of patients by socioeconomic dimensions or other relevant factors (e.g., gender, age, health literacy), complemented with a contextual analysis to detect barriers to the implementation.
The planned COMPAR-EU end-products, that will be integrated in the online COMPAR-EU platform include but are not limited to: taxonomy of SMIs, COS for each disease, ranking of effective SMIs, list of most cost-effective SMIs, report on contextual factors, Interactive Summary of Findings, Evidence to decision frameworks and Patient-Professional Decision Aids.
For more detail on the end-products including the relation between end-products and end-users see figure 1.
With this end-products we plan to reach all the expected impacts that were set up in the call, providing the required evidence base:
• … for more effective and safer SMIs interventions at an individual and population level, for patients living with T2DM, obesity, COPD, and/or heart failure, including effectiveness, cost-effectiveness and contextual analysis.

• … for enhanced adherence to SMIs, by developing interactive decision-making tools tailored to the health system, organisations, and patients-prescriber interaction.

• … to introduce novel methodologies for the synthesis of evidence (network meta-analysis [NMA] and cost-effectiveness modelling) in health technology assessment methodology.

• … for the improvement of individual patient outcomes and health outcome predictability through tailoring of interventions by NMA and cost-effectiveness modelling, providing results per individual outcome and patient subgroups.

• … for the improvement of guideline development for prevention or treatment of diseases and the management of comorbidities, enhancing self-management as a possible treatment and the inclusion of patient-preferred outcomes in COS in future guidelines.

• … for the provision of more accurate information to patients, caregivers and prescribers, giving them access to evidence tailored to their needs, though online decision-making tools and other end-product.
Other substantial impacts:
Societal benefits: contributing to the sustainability and efficiency of healthcare systems
We intend to generate deep insights into the economic consequences of adopting more SMIs in Member States, including: quantification of productivity gains, budget impact, economic consequences for patients and of health lost upon not adopting the best SMIs.
Strengthening EU competitiveness: though the enhancement of innovation capacity
We’ll contribute to the EU’s innovation capacity identifying new market opportunities by ranking the most effective and cost-effective SMIs (interventions with a potential business value); identifying new collaboration opportunities by detecting promising SMIs, areas that could benefit from a collaboration between academia and industry; reducing wasteful investments by identifying already saturated areas of SMIs and building research capacity, training young researchers.

Website & more info

More info: https://self-management.eu/.