What does it mean? Comparative effectiveness quite simply means comparing two or more treatments for a given condition. Studies may compare similar treatments, such as two drugs, or it may analyze very different approaches, such as surgery and drug therapy. Comparative effectiveness evaluations may focus only on the relative medical benefits and risks of each option, or they may also weigh both the costs and the benefits of those options. In some cases, a given treatment may prove to be more effective clinically or more cost-effective for a broad range of patients, but frequently a key issue is determining which specific types of patients would benefit most from it.
Why the buzz? Comparative effectiveness is increasingly being viewed as a viable way to help drive down spiraling health care costs while continuing to provide quality care. Roughly $700 billion each year goes to health-care spending that can’t be shown to lead to better health outcomes, according to the non-partisan Congressional Budget Office. Last year legislation was introduced in Congress to establish an ambitious comparative effectiveness program created by the federal government, including establishing the Health Care Comparative Effectiveness Research Institute to review evidence and produce new information on how diseases, disorders, and other health conditions can be treated to achieve the best clinical outcome for patients. Lawmakers and the Obama Administration are pushing to include $1.1 billion in the economic stimulus package (approved today) for comparative effectiveness. Proponents say the Institute would work with experts and stakeholders to prioritize treatments for research–including surgical procedures, pharmaceuticals, medical devices, and other measures. The research would be carried out by public and private organizations approved by the Institute’s board of directors, including doctors, patients, and pharmaceutical and biotechnology companies. The results would then be made available to clinicians, patients, and the public.
Critics such as the Cato Institute contend such a government-created comparative effectiveness effort “will be a complete waste of time and money.” Cato says a better way to generate comparative-effectiveness information would be for Congress to eliminate government activities that it says suppress private production, including allowing workers and Medicare enrollees to control the money that purchases their health insurance. Such a laissez-faire approach would both increase comparative-effectiveness research and increase the likelihood that patients and providers would use it, according to Cato. This will all continue to play out in the months ahead and increasing scrutiny of the evidence behind medical interventions is always a good thing.
National Working Group on Evidence Based Healthcare, Johns Hopkins University
—Bob Williams, strategic resource director, Consumers Union