Heterogeneity in action: the role of passive personalization in comparative effectiveness research

Health Econ. 2014 Mar;23(3):359-73. doi: 10.1002/hec.2996. Epub 2013 Oct 9.


Despite the goal of comparative effectiveness research (CER) to inform patient-centered care, most studies fail to account for the patient-centeredness of care that already exist in practice, which we denote as passive personalization (PP). Because CER studies describe the average effectiveness of treatments rather than heterogeneity in how individual patients respond to therapies, clinical or coverage policies that respond to CER results may undermine PP in clinical practice and generate worse outcomes. We study this phenomenon empirically in the context of use of antipsychotic drugs in Medicaid patients with schizophrenia using novel instrumental variable methods. We find strong support for PP in clinical practice and demonstrate that the average effects from a CER study cannot be replicated in practice because of the presence of PP. In contrast, providing physicians with evidence to further personalize treatment can produce significant benefits.

Keywords: antipsychotic drugs; comparative effectiveness; heterogeneity; passive personalization; schizophrenia.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Antipsychotic Agents / therapeutic use
  • Comparative Effectiveness Research* / statistics & numerical data
  • Female
  • Health Policy
  • Humans
  • Male
  • Medicaid / statistics & numerical data
  • Models, Econometric
  • Precision Medicine / psychology
  • Precision Medicine / standards
  • Precision Medicine / statistics & numerical data*
  • Schizophrenia / drug therapy
  • Treatment Outcome
  • United States


  • Antipsychotic Agents