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Potential harm caused by physicians a-priori beliefs in the clinical
effectiveness of hydroxychloroquine and its impact on clinical and economic
outcome - A simulation approach
#MMPMID33383306
Ebm C
; Carfagna F
; Edwards S
; Mantovani A
; Cecconi M
J Crit Care
2021[Apr]; 62
(?): 138-144
PMID33383306
show ga
BACKGROUND: Despite growing controversies around Hydroxychloroquine's
effectiveness, the drug is still widely prescribed by clinicians to treat COVID19
patients. Therapeutic judgment under uncertainty and imperfect information may be
influenced by personal preference, whereby individuals, to confirm a-priori
beliefs, may propose drugs without knowing the clinical benefit. To estimate this
disconnect between available evidence and prescribing behavior, we created a
Bayesian model analyzing a-priori optimistic belief of physicians in
Hydroxychloroquine's effectiveness. METHODOLOGY: We created a Bayesian model to
simulate the impact of different a-priori beliefs related to Hydroxychloroquine's
effectiveness on clinical and economic outcome. RESULTS: Our hypothetical results
indicate no significant difference in treatment effect (combined survival benefit
and harm) up to a presumed drug's effectiveness level of 20%, with younger
individuals being negatively affected by the treatment (RR 0.82, 0.55-1.2; (0.95
(1.1) % expected adverse events versus 0.05 (0.98) % expected death prevented).
Simulated cost data indicate overall hospital cost (medicine, hospital stay,
complication) of 18.361,41? per hospitalized patient receiving Hydroxychloroquine
treatment. CONCLUSION: Off-label use of Hydroxychloroquine needs a rational,
objective and datadriven evaluation, as personal preferences may be flawed and
cause harm to patients and to society.
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