Trade-off Indices

TURBO (Transparent Uniform Benefit Risk Overview)


1. Description

TURBO (Transparent Uniform Benefit Risk Overview) is a BR concept which prioritises two most important benefit and risk criteria.[1][2] TURBO is a simple multi-criteria decision model: (1) score the primary benefit on a scale 1-5; (2) score the ancillary benefit on a scale 1-2; (3) score the most important risk on a scale 1-5; (4) score additional risk on a scale 0-2; (5) add the two benefits ("B" factor) and risks ("R" factor) in their respective dimensions to obtain benefit and risk scores; (6) plot the two scores against each other to produce the 'T' score.

2. Evaluation

2.1 Principle
  • TURBO assumes only two benefit criteria and two risk criteria really matter, corresponding to the primary and secondary benefits and risks respectively.
  • The second criterion in each dimension is regarded as the correction factor to the first and scored on a shorter scale than the first.
  • The scores for each benefit and risk may be determined prior to making any judgment based on the intrinsic characteristics of the disease, drug and population.
  • The T-score is defined ad hoc.
  • It is too simple to be transparent or of any use in drug benefit-risk decision-making.

2.2 Features
  • TURBO is simple and quite intuitive.
  • Its restrictions to two benefits and two risks limit its usefulness for formal benefit-risk assessment.
  • The proposed secondary (ancillary) benefit is unclear as to what it should represent.
  • The idea of accounting for two most important risks is also unjustified as the risk profile of a treatment cannot always be solely driven by just two risks.

2.3 Visualisation
  • A TURBO grid is proposed where the T-scores are defined ad hoc.

2.4 Assessability and
  • TURBO is too simplistic to be considered for the application in drug benefit-risk decision-making.

3. References

[1] CIOMS Working Group IV. Benefit-Risk Balance for Marketed Drugs. Evaluating Safety Signals. 1998. Geneva, Council for International Organizations of Medical Sciences.
[2] Mussen F, Salek S, Walker S. Review of the Current Benefit-Risk Assessment Models. Benefit-Risk Appraisal of Medicines. 1 ed. John Wiley & Sons, Ltd.; 2009. p. 63-97.