P2‐287: The impact of clinician judgment on the decision to insure a medication for Alzheimer's disease
Bibliographic record
Abstract
Evidence for the efficacy of Alzheimer's disease (AD) medications takes the form of changes in scale score. This study examined whether the additional consideration of clinician judgment would affect formulary committee members' recommendations for insuring an AD medication. Members of Canadian formulary committees were asked to complete a survey containing four randomly ordered scenarios about a hypothetical, new AD medication. Two ‘stabilization’ scenarios described cognitive scale scores as remaining stable for 12 months, after which the scores fell to indicate cognitive decline; two ‘disease modification’ scenarios described the scores as plateauing and remaining constant throughout a 24-month follow-up period (no decline). One stabilization and one disease modification scenario contained additional information in the form of clinician judgment. This judgment was that 20 months of improved performance over placebo would be a clinically significant outcome for the new medication. For each scenario, respondents' likelihood of recommending that the new medication be insured was measured on a 7-point Likert scale: 1 = not at all likely; 7 = very likely. Thirty-two respondents were required to detect a difference of 0.5 points on the Likert scale (80% power, 5% level of significance). Sixty-seven persons were contacted to obtain 32 responses. Respondents and non-respondents did not differ by sex (p > 0.4) or region of residence (p > 0.5). The difference in mean likelihood scores was greater (p = 0.02) for both stabilization and disease modification when clinician judgement was added to the data on scale scores, compared to when only scale scores were provided as evidence of efficacy (difference in mean likelihood: stabilization = 0.062; disease modification = 0.656). Clinician judgment, when added to data on changes in scale score, interacts with drug effect (stabilization, disease modification) to increase formulary committee members' likelihood of recommending that an AD medication be insured. Further research should investigate whether the results would change at clinically significant thresholds other than 20 months.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.020 | 0.159 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.011 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".