Series: Pragmatic trials and real world evidence: Paper 5. Usual care and real life comparators

Zuidgeest, Mira G; Welsing, Paco; van Thiel, Ghislaine; Ciaglia, Antonio; Alfonso-Cristancho, Rafael; Eckert, Laurent; Eijkemans, Marinus J C; Egger, Matthias (2017). Series: Pragmatic trials and real world evidence: Paper 5. Usual care and real life comparators. Journal of clinical epidemiology, 90, pp. 92-98. Elsevier 10.1016/j.jclinepi.2017.07.001

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Pragmatic trials may deliver real world evidence on the added value of new medications compared to usual care and inform decision making earlier in development. This 5(th) paper in a series on pragmatic trials in the Journal discusses usual care as a comparator and the allocation of treatment strategies. The allocation and implementation of treatment strategies should resemble clinical practice as closely as possible. Randomization at the level of the site, as opposed to at the individual level, may be preferred. Data analysis according to the intention-to-treat principle is recommended, and crossover between treatment arms and strong treatment preferences may be accounted for in the study design in specific situations. Although usual care is the comparator of choice, this may differ substantially between centres and countries complicating comparator choice. Using clinical guidelines to define usual care can be helpful in standardizing comparator treatments, however, this may decrease the applicability of the results to real life settings. Conversely, using multiple usual care treatment arms will increase the complexity of the study. The specific objectives of the trial and design choices should be discussed with all stakeholders to realize the full potential of the pragmatic trial.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

UniBE Contributor:

Egger, Matthias


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services








Beatrice Minder Wyssmann

Date Deposited:

05 Sep 2017 10:27

Last Modified:

16 Nov 2017 13:19

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Real-world evidence; Pragmatic trial; Usual care; Comparator choice; Treatment strategy; Routine clinical practice




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