Letters Fourth, Kemble and colleagues referenced flat or declin- Using Patient Preferences to Determine ing revenues for the majority of physicians in 3PC. However, Noninferiority Margins in Trials according to the HMSA (Emily Oshima Lee, verbal communi- To the Editor A 2016 systematic review of noninferiority trials cation, August 27, 2019), it increased aggregate payments to showed that most provided ambiguous or limited informa- PCPs by 20% in the 3PC’s first 3 years. Consequently, a signifi- tion to justify the noninferiority margins used to size them. cant majority have increased their revenues. Dr Acuna and colleagues advocated incorporating patient Fifth, that the HMSA model did not drive year-1 cost sav- preferences in designing noninferiority deimplementation ings is testament to the transitional process the HMSA devel- trials using probability trade-off techniques. For example, an oped with the PCPs and physician organizations. The lack of early-stage breast cancer trial considering forgoing axillary savings cannot be an indictment of a model that provided only lymph node dissection (ALND) would lessen adverse effects bonuses, not penalties, to physicians to protect them as they (eg, lymphedema) at the cost of slightly worse survival. transitioned to 3PC. Patients would be presented with probability trade-off situa-
JAMA – American Medical Association
Published: Dec 3, 2019
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