The Facts about Comparative Effectiveness Research

2009-07-07

Executive Summary

As Congressional and public debate over health care reform grows more intense, comparative effectiveness research (CER) has emerged as an unlikely flashpoint of controversy. Opponents’ claims that CER results in the rationing of health care or a government takeover are belied by the true nature of such research: it is simply fundamental scientific research of medical treatments aimed at determining the most effective ways to treat sickness and injury. It is the basis of all advancements in the field of medical science and has been used throughout history to improve medical treatment. The results of such research are used to create treatment guidelines, which are then incorporated by physicians in determining the best course of care for each individual patient.

The tremendous need for this research is made clear by studies showing that only a minority of medical treatments currently being used are supported by valid research. As medical innovation accelerates, and new techniques, drugs, and devices enter the market daily, the need to gauge the effectiveness of these innovations increases.

Failure to use effective treatments results in worse medical outcomes and higher medical costs, resulting from the need to re-treat patients or to address complications following ineffective treatment. Evidence-based medical protocols, developed from the findings of CER, have been shown to yield cost savings and improvements to patient health.

A recent report released by the Institute of Medicine of the National Academies concluded that “the country needs a robust CER infrastructure” and listed the top 100 priority topics for comparative effectiveness research.

Opponents claim that CER will mandate doctors’ treatment options. Generating data on effective medical treatment is a separate issue from the use of that data. These studies are a tool that can assist doctors in determining the best treatment for their patients, in conjunction with their own knowledge of the unique needs of each patient. In some cases, the results of CER indicate that there is in fact a best practice that should be followed in nearly all circumstances. In others, research can help establish which kinds of patients are most likely to benefit from which treatment options. Doctors and care providers should be encouraged to keep current with effectiveness research findings and use them to improve patient care.

Much of this research today is conducted or paid for by the manufacturers of the drugs or medical devices being tested. Such research has been shown to be biased toward a finding that the drug or device is beneficial. Thus it is necessary that CER be funded by neutral parties who do not have an economic interest in the result. The federal government is ideally situated to perform such research and to fund nonprofit institutions to do it.

To improve patient care and reduce the costs of unnecessary and improper treatment, the federal government should expand its funding and support for comparative effectiveness research.