Comparative Effectiveness
Encyclopedia
Comparative effectiveness research (CER) is the direct comparison of existing health care
interventions to determine which work best for which patients and which pose the greatest benefits and harms. The core question of comparative effectiveness research is which treatment works best, for whom, and under what circumstances.
The Institute of Medicine committee has defined CER as "the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. The purpose of CER is to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels."
An important component of CER is the concept of Pragmatic Trials. These clinical research
trials measure effectiveness—the benefit the treatment produces in routine clinical practice. This is different than many regularly clinical trial
s, which measure efficacy
, whether the treatment works or not.
Dr.John Wennberg
and his colleagues at The Dartmouth Institute for Health Policy and Clinical Practice have spent over 40 years documenting geographic variation in health care that patients in the U.S. receive - a phenomenon called practice pattern variation.
The Dartmouth researchers concluded that if unwarranted variation were eliminated, the quality of care would increase and health care savings up to 30% would be possible - a statistic that has been often repeated in the case for CER.
Several groups have emerged to provide leadership in the area of Comparative Effectiveness Research. The Agency for Healthcare Research and Quality (AHRQ) is a federal agency
focused on health care quality, while the Center for Medical Technology Policy is a non-profit organization that brings disparate health care stake holders together to build consensus on practical models for comparative effectiveness research. ECRI Institute has undertaken systematic reviews of clinical procedures using metaanalysis for the Medicare program, other federal and state agencies and clinical specialty organizations.
in medical treatment, cost, and outcomes suggests a substantial area for improve and savings in our health care system. Statistical findings show that "patients in the highest-spending regions of the country receive 60 percent more health services than those in the lowest-spending regions, yet this additional care is not associated with improved outcomes." New models of shared decision making promise to bring greater emphasis to informed patient choice for "preference-sensitive" care, improving quality, safety, and effectiveness of health care by providing both patients and their health care providers with the evidence to assist in informed decision making.
In 2009, $1.1 Billion of President Obama
's stimulus package
was earmarked for CER.. There was initial disagreement regarding whether CER will be used to limit patient health care options, or help lower health care costs. Ultimately the bill approved by Senate contains measures to utilize CER as a means for increasing quality while reducing rising costs.
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
interventions to determine which work best for which patients and which pose the greatest benefits and harms. The core question of comparative effectiveness research is which treatment works best, for whom, and under what circumstances.
The Institute of Medicine committee has defined CER as "the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. The purpose of CER is to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels."
An important component of CER is the concept of Pragmatic Trials. These clinical research
Clinical research
Clinical research is a branch of medical science that determines the safety and effectiveness of medications, devices, diagnostic products and treatment regimens intended for human use...
trials measure effectiveness—the benefit the treatment produces in routine clinical practice. This is different than many regularly clinical trial
Clinical trial
Clinical trials are a set of procedures in medical research and drug development that are conducted to allow safety and efficacy data to be collected for health interventions...
s, which measure efficacy
Efficacy
Efficacy is the capacity to produce an effect. It has different specific meanings in different fields. In medicine, it is the ability of an intervention or drug to reproduce a desired effect in expert hands and under ideal circumstances.- Healthcare :...
, whether the treatment works or not.
Dr.John Wennberg
John Wennberg
John E. "Jack" Wennberg is the pioneer and leading researcher of unwarranted variation in the healthcare industry. Through four decades of work, Wennberg has documented the geographic variation in the healthcare that patients in the United States receive...
and his colleagues at The Dartmouth Institute for Health Policy and Clinical Practice have spent over 40 years documenting geographic variation in health care that patients in the U.S. receive - a phenomenon called practice pattern variation.
The Dartmouth researchers concluded that if unwarranted variation were eliminated, the quality of care would increase and health care savings up to 30% would be possible - a statistic that has been often repeated in the case for CER.
Several groups have emerged to provide leadership in the area of Comparative Effectiveness Research. The Agency for Healthcare Research and Quality (AHRQ) is a federal agency
Federal agency
Federal agency may refer to:*United States federal agencies—see List of United States federal agencies*Federal agency -See also:*Government agency*Statutory corporation*Statutory Agency*Crown corporation*Government-owned corporation...
focused on health care quality, while the Center for Medical Technology Policy is a non-profit organization that brings disparate health care stake holders together to build consensus on practical models for comparative effectiveness research. ECRI Institute has undertaken systematic reviews of clinical procedures using metaanalysis for the Medicare program, other federal and state agencies and clinical specialty organizations.
In the 2010 U.S. health care reform
The rising cost of medical care in the U.S. has triggered an immediate need for better value in our health system. Researchers at the Dartmouth Institute for Health Policy, in addition to the Congressional Budget Office, have documented a large gap in the quality and outcomes and health services being delivered. Unwarranted variationUnwarranted variation
Unwarranted variation in healthcare service delivery, first so termed by Dr. John Wennberg, refers to differences that cannot be explained by illness, medical need, or the dictates of evidence-based medicine...
in medical treatment, cost, and outcomes suggests a substantial area for improve and savings in our health care system. Statistical findings show that "patients in the highest-spending regions of the country receive 60 percent more health services than those in the lowest-spending regions, yet this additional care is not associated with improved outcomes." New models of shared decision making promise to bring greater emphasis to informed patient choice for "preference-sensitive" care, improving quality, safety, and effectiveness of health care by providing both patients and their health care providers with the evidence to assist in informed decision making.
In 2009, $1.1 Billion of President Obama
Barack Obama
Barack Hussein Obama II is the 44th and current President of the United States. He is the first African American to hold the office. Obama previously served as a United States Senator from Illinois, from January 2005 until he resigned following his victory in the 2008 presidential election.Born in...
's stimulus package
American Recovery and Reinvestment Act of 2009
The American Recovery and Reinvestment Act of 2009, abbreviated ARRA and commonly referred to as the Stimulus or The Recovery Act, is an economic stimulus package enacted by the 111th United States Congress in February 2009 and signed into law on February 17, 2009, by President Barack Obama.To...
was earmarked for CER.. There was initial disagreement regarding whether CER will be used to limit patient health care options, or help lower health care costs. Ultimately the bill approved by Senate contains measures to utilize CER as a means for increasing quality while reducing rising costs.
Further Information
- Carroll, John (6/2011). "Payers Step in With ‘Real-World’ Comparative Effectiveness Research" Managed Care Magazine.
- Thill, Mark (2010). "CER and Personalized Medicine Face Hurdles" Journal of Healthcare Contracting.
- Alexander GC, Stafford RS. Does comparative effectiveness have a comparative edge? JAMA. 2009;301:2488-2490.
- In 2009, The Institute of Medicine released Initial National Priorities for Comparative Effectiveness Research(CER). This report is designed to assist patients and healthcare providers across diverse settings in making more informed decisions. In this report, the Institute of Medicine's Committee on Comparative Effectiveness Research Prioritization establishes a working definition of CER, develops a priority list of research topics, and identifies the necessary requirements to support a robust and sustainable CER enterprise.
- In April 2009, the New England Healthcare InstituteNew England Healthcare InstituteNEHI is an independent, nonprofit national network and research organization focused on enabling innovation to improve health care quality and lower health care costs. In partnership with members from all across the health care system, NEHI conducts evidence-based research and stimulates policy...
released a white paperWhite paperA white paper is an authoritative report or guide that helps solve a problem. White papers are used to educate readers and help people make decisions, and are often requested and used in politics, policy, business, and technical fields. In commercial use, the term has also come to refer to...
identifying ways to design and implement the new federal comparative effectiveness research program without stifling valuable innovation in health care.
- Comparative effectiveness research is conducted by AHRQ through its Effective Health Care Program http://effectivehealthcare.ahrq.gov/.
- Weinstein MC, O'Brien B, Hornberger J, et al. Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR Task Force on Good Research Practices—Modeling Studies. Value Health 2003; 6:9-17.
- Hornberger J, Wrone E. When to base clinical policies on observational versus randomized trial data. Ann Intern Med 1997; 127(Part 2):697-703.
- Weinstein MC, O'Brien B, Hornberger J, et al. Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR Task Force on Good Research Practices—Modeling Studies. Value Health 2003; 6:9-17.
- Hornberger J, Robertus K. Comprehensive evaluations of healthcare interventions: The realism – transparency tradeoff. Med Decis Making 2005; 25:490-2.
External links
- Doing Their Homework: Times Reporters Respond in Dartmouth Atlas Spat. Goozner, Merrill.
- "Comparative effectiveness research" and Kindred Delusions. Hadler, Nortin.
- A Tale of Two Diseases: Repairing Comparative Effectiveness Research. Williams, David.
- Cedar Associates LLC - Clinical Effectiveness Decision Analytical Research
- http://www.economist.com/debate/overview/155 Economist Magazine debate on the motion "This house believes that the widespread use of comparative effectiveness reviews and cost/benefit analyses will stifle medical innovation and lead to an unacceptable rationing of health care. (Supporting the motion: Newt GingrichNewt GingrichNewton Leroy "Newt" Gingrich is a U.S. Republican Party politician who served as the House Minority Whip from 1989 to 1995 and as the 58th Speaker of the U.S. House of Representatives from 1995 to 1999....
Former Speaker of the U.S. House of Representatives and Founder, Center for Health Transformation. Against the motion: Sir Michael RawlinsMichael RawlinsSir Michael Rawlins is the chairman of the National Institute for Health and Clinical Excellence .- Education :Rawlins obtained his undergraduate medical degree at St Thomas' Hospital, graduating in 1965...
Chairman, National Institute for Health and Clinical Excellence (NICE)). - http://www.value-strategies.info/comparative-effectiveness offers explanations of clinical and economic comparative effectiveness