Comparative Effectiveness Research—Implications for Healthcare

Healthcare costs have been steadily increasing across the globe. In the US alone, healthcare expenditure reached $2.5 trillion in 2009, which translates to 17.6% of the nation’s GDP.¹ In 1999, the figure was an estimated $1.3 trillion or 13.8% of GDP. In Westernized nations, an aging population, the growing prevalence of chronic diseases, and the introduction of novel medical technologies (in the form of drugs and devices) has significantly contributed to escalating healthcare costs. In an effort to stem these rising costs, governments, healthcare providers and payors, and healthcare consumers are placing much greater emphasis on value, for new treatments and medical technologies.

In this new era of cost-constraints, comparative effectiveness research (CER), the basic principle of which is comparing the benefits and harms of alternative healthcare technologies or interventions, has been proposed as an important tool to manage escalating healthcare costs. Indeed, CER is at the centre of the current US healthcare reform policy. In 2009, $1.1 billion of federal funds were allocated to support CER, as part of the American Recovery and Reinvestment Act, which is also known as the stimulus bill. The CER funds were divided between the Agency for Healthcare Research and Quality ($300 million), the National Institutes of Health ($400 million) and the Department of Health and Human Services ($400 million). The Institute of Medicine was contracted to determine the priorities for CER in the US.

Variations of CER are already in place in other countries in the form of health technology assessment (HTA) agencies, such as the UK National Institute for Health and Clinical Excellence and the Australian Pharmaceutical Benefits Advisory Committee. These agencies have a common purpose: to demonstrate the effectiveness/usefulness of a procedure or treatment with supportive evidence. The consensus is that CER/HTAs will reduce the knowledge gaps that lead to uneven healthcare provision and provide evidence of value for the current and novel interventions and protocols. However, the counter-argument is that CER/HTAs may be used to control costs by removing choice from consumers.

For leading healthcare industry analyst Dr Jeff Goldsmith, President of Health Futures, Inc. and Associate Professor of Public Health Sciences at the University of Virginia, CER represents a mechanism to “inform healthcare coverage and payment decisions going forward, and should deliver reliable information to consumers regarding effectiveness, benefits, and safety related to different treatment options. The research should provide data that compare drugs, medical devices, diagnostics, surgical protocols, and even healthcare delivery—generating evidence that drives CER.