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What is comparative effectiveness and why is it relevant to healthcare reform? March 4, 2010

Posted by mtaliafe in Healthcare, Uncategorized.
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We consider ourselves to be in a scientific society, right? You might be surprised to know that a lot of the science upon which medicine has been built has been conducted in silos. Researchers might investigate drugs in clinical trials, or medical devices in practice. However, the results of these studies as published are more case-based and don’t take into account the other treatment options. Essentially, they often don’t address how the new treatment compares to those already out there, or how it might be used in conjunction with other therapies. Healthcare providers sometimes lack knowledge of which therapies out of all possible treatments are the most effective ones.

The Obama Administration is proposing to spend $286 million in 2011 on comparative effectiveness research (CER) according to Carey and Appleby of the Kaiser Family Foundation. The topic of comparative effectiveness has been often picked up by the media in light of healthcare reform, since it has been identified as one tool to reduce healthcare spending. The Department of Health and Human Services (HHS) has defined comparative effectiveness as:

The conduct and synthesis of research comparing the benefits and harms of different interventions and strategies to prevent, diagnose, treat and monitor health conditions in “real world” settings. The purpose of this research is to improve health outcomes by developing and disseminating evidence-based information to patients, clinicians, and other decision-makers, responding to their expressed needs, about which interventions are most effective for which patients under specific circumstances.

Much has been written in the last decade on comparative effectiveness, but policy and government have not made a concerted effort to fund it or put it to use. That isn’t to say there haven’t been attempts going back all the way to the 1970’s, with the Congressional Office of Technology Assessment. The last big push was the Agency Health Care Policy & Research (AHCPR) Clinical Guidelines effort.   This agency is now known as the Agency for Healthcare Research and Quality (AHRQ) and has been identified as the institution that would administer the funds.

We need to be concerned with this as healthcare spending has an increasingly large share of our Gross Domestic Product (GDP). For example, in 2007, healthcare spending commanded about 17% of the GDP according to the Congressional Budget Office. It is predicted to rise to 25% in 2025 if no changes are made to our healthcare system. Comparative effectiveness research has been repeatedly suggested as one way of controlling healthcare costs. Often, this phenomenon of reducing healthcare costs in comparison to our productivity has been termed “bending the curve”.

According to the New York Times’ Barry Meier, critics of funding comparative effectiveness say , that it will lead to rationing healthcare. One group critical of the effort is Partnership to Improve Patient Care as it feels that the use of CER will lead to a “one-size-fits-all” approach to healthcare. For that reason, proponents of CER have refashioned the terminology for the practice as “patient-centered health research” in an attempt to shift the semantics of the topic.

Within a year’s time, it will be interesting to see where the U.S. is with comparative effectiveness research. Surely, there will be more data on its applicability to controlling healthcare costs.

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