Comparing treatment outcomes will only improve them
As you know, few provisions in the American Recovery and Reinvestment Act of 2009 generated as much debate as the $1.1 billion allotted for comparative effectiveness research.
The legislation's spotlight on this evolving research enterprise has raised many questions. Will comparative effectiveness research affect physicians' autonomy? How much bearing should research findings have on clinical and payment decisions? Which clinical comparative effectiveness studies represent the best investments for federal research dollars? How should treatment effectiveness be analyzed? Should treatment costs be assessed? If so, who should do it?
As a physician, a health service researcher and the director of the federal Agency for Healthcare Research and Quality (AHRQ), I count myself among those most excited about the new and enhanced opportunities for comparative effectiveness research.
Before I explain why, let me review how the funding will be used, outline how funding decisions will occur, and highlight how we've already begun to answer some of these questions.
Boost an existing program
Of the $1.1 billion allocation, $300 million is targeted to the AHRQ to build on its Effective Health Care Program. Created by the Medicare Prescription Dr.ug, Improvement, and Modernization Act of 2003, this program assists patients and clinicians in making evidence-based health care decisions by analyzing and summarizing high-quality research and funding new research. We then tailor these research findings for different audiences. The success of this program depends on the public's involvement, including the opportunity to suggest research topics, comment on draft reports and participate in listening sessions. Transparency for all parties—physicians and other health care professionals, patients and their families, insurers, professional organizations—is an important attribute of the Effective Health Care Program.
Some of the summary guides for clinicians compare treatments for patients with knee osteoarthritis, treatments for men with clinically localized prostate cancer, and oral medications for adults with type 2 diabetes mellitus. Recently published guides have examined the effectiveness and safety of bare metal and drug-eluting cardiac stents.
The remaining $800 million for comparative effectiveness research in the Recovery Act will be divided equally between the National Institutes of Health and the Office of the Secretary of the U.S. Department of Health and Human Services.
To guide the HHS on how to use its funding, the Recovery Act established the Federal Coordinating Council for Comparative Effectiveness Research, of which I am a member.
Since March, the 15-member council has held three listening sessions, during which the public and stakeholder organizations have commented about funding priorities. At each of these listening sessions, I've been impressed with the awareness of how much critical information we lack on certain health care services and procedures.
Based on input from these listening sessions and from other stakeholders, the council released a report in June recommending that HHS use the $400-million funding to do the following:
- Focus on the needs of racial and ethnic minorities, persons with disabilities, persons with multiple chronic conditions, the elderly, and children.
- Target specific high-impact areas, such as medical and assistive devices, surgical procedures, behavioral interventions, and prevention.
- Invest in data infrastructure, such as linking current data sources in order to address comparative effectiveness research questions and developing distributed electronic-data networks.
The stimulus legislation also called on the National Academies' Institute of Medicine to gather input from stakeholders and recommend national priorities for comparative effectiveness research.