Choosing Wisely: Applying Value-Based Economic Principles to Population Science Research Investment.

"Authors' Disclosures K.D. Frick reports personal fees from NCI during the conduct of the study. No disclosures were reported by the other author."

"Innovation is considered at both scientific peer review and programmatic review. Tensions exist among the values of innovation, reproducibility, and generalizability. Funding mechanisms such as the “High Risk, High Reward Research Program” () emphasize novel and transformative research; however, research that settles areas of uncertainty, uses existing resources to inspire new questions and apply existing approaches or technology in novel ways is valuable. With limited resources, the opportunity costs may become too great when research perseverates and does not advance to translate the results to the clinical and population setting (). The path from research project inception to translation and implementation is frequently long and circuitous. Once research is initiated, ongoing evaluation should inform decisions of whether to continue on the original path, fund routes similar to but divergent from the original path, or abandon the path entirely. Funding to support research operates in the reality of the growing demand for limited resources; difficult allocation choices must be made. Economic value-driven questions can be tailored to the project under review and priorities of the funder; these serve as a guide in decision-making for the allocation of research time, effort, and funding. The proposed framework provides a transparent, structured, pragmatic process to consider and discuss tradeoffs and facilitate transparent decisions concerning initiation of new projects and continuation of ongoing projects in the context of limited resources. Consistent application of the framework to funding decisions may help to improve transparency, minimize bias by making the evaluation process more explicit, and, thus, optimize the use and distribution of limited resources. This commentary was stimulated by our collective experience and observations as researchers developing projects, peer reviewers, and participants in programmatic funding reviews and decisions across multiple sponsor organizations. We hope that through this commentary, researchers become more aware of the programmatic review stage and will have the opportunity to enter into a dialogue concerning how the research community could be engaged to arrive at a consensus on how the questions suggested (for which there are not any absolutely correct answers) could be put into practice in a research planning and decision-making process. It is notable that most major sponsors include investigators in both levels of the review process (e.g., NIH councils and CDMRP programmatic reviews include members from the research community), and a broad dialogue should take place. We are not proposing a new review system but are suggesting guidance for discussion that can help increase transparency and level the playing field for consideration of meritorious applications."