1. Causal Comparative Effectiveness Farrokh Alemi, Ph.D.

2. Causal Comparative Effectiveness Comparative effectiveness Reduce cost Improve quality Enabled by EHRs For example, Vioxx studies

3. An Example

5. Causal Comparative Effectiveness Expose Mislead

6. Causal Comparative Effectiveness Expose Mislead

7. Improving Effectiveness Studies Increase accuracy of severity measures Tests for causality of findings

8. Improving Effectiveness Studies Increase accuracy of severity measures Tests for causality of findings Facts Counter factuals

9. Traditional Approach

10. Causal Analysis 1. Association between cause and effect

11. Causal Analysis 1. Association 2. Causes must precede effects

12. Causal Analysis 1. Association 2. Causes precede effects 3. Clear mechanism

13. Causal Analysis 1. Association 2. Causes precede effects 3. Clear mechanism 4. Common causes are conditionally dependent

14. Causal Analysis 1. Association 2. Causes precede effects 3. Clear mechanism 4. Common causes are conditionally dependent 5. Counterfactuals Not using Vioxx should reduce excess mortality

15. Progress in Causal Analysis Judea Pearl Simultaneous equations Graphs Probability models

16. Simultaneous Equations

19. Severity of Illness Used in simultaneous equations Counterfactuals Expected outcomes in absence of intervention

20. Causal Effectiveness Studies Can Reduce Misleading Inferences