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Research Can Lead to Lower Health Costs and Improved Outcomes

By Dr. Clark Hinderleider

In the past Comparative Effectiveness Research (CER) was the province of a small cadre of scientists and policy analysts: the Agency for Health Care Research and Quality has funded some 28 centers which have produced a wealth of evidence-based data on the cost effectiveness and efficacy of drugs, medical devices and procedures currently used in clinical medicine.  On February 17, 2009 President Obama signed the American Recovery and Reinvestment Act allocating $1.1 billion for CER studies that directly compare the risks and benefits of different treatments for a particular condition and are essential for improving care and controlling health care costs. [1] The Act also mandated the Institute of Medicine to recommend “national priorities for comparative research.” [2,3,4].  It should be noted that the Federal Coordinating Council for CER, whose task was to coordinate such research would NOT be able to establish clinical guidelines or to “mandate coverage, reimbursement, or other policies for any public or private payer.” [5] A new tax in the PPACA [6] will translate into annual CER funding that will reach an estimated $500 million in 2014. [7] This will finance the creation of the non-profit corporation, Patient-Centered Outcomes Research Institute, whose findings can not be used to determine “coverage, reimbursement, or incentive programs” under Medicare “in a manner that treats extending the life of an elderly, disabled, or terminally ill individual as of lower value than extending the life of an individual who is younger, nondisabled, or not terminally ill.”  These factual inclusions have been ignored by critics, including the “death panel” ignorante.  One must wonder if these have read and understood the Acts.

The best definition for the process is seen in the IOM Brief [v.s.]: “CER is 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.” There is no directive on “rationing,” but instead science-based, cost-effective provision of quality health care is mandated. It is intuitive that, if less costly, non-inferior methodology is used, the escalating costs can only fall. [8, 9,10,11,12

Federal legislative interest in CER produced a modest role for CER in the 2003 Medicare Modernization Act which instructed the Secretary of HHS to support research with a focus on outcomes, comparative clinical effectiveness and appropriateness of devices, pharmaceuticals and services. This trend has been accelerated to date with identification of issues that must be addressed.  Foremost is the education of the nescient opponents, a task made more formidable by the depth of such misinformation and the confounding political bias. To be sure, in order to affect change in the cost and quality of health care, the importance of CER must be recognized and promoted. [13,14,15,16]

1. The American recovery and Reinvestment Act of 2009 (accessed at

2. Institute of Medicine, “initial National Priorities For Comparative Effectiveness Research,” Report Brief, June 2009

3. Kuehn, BM, “Institute of Medicine Outlines Priorities for Comparative Effectiveness Research,” JAMA 2009; 302:936-7

4. Iglehart, JK, “Prioritizing Comparative Effectiveness Research—IOM Recommendations,” NEJM 2009; 361(4):325-7

5. Conway, PH, et al., “Comparative Effectiveness Research—Implications of the Federal Coordinating Council’s Report,” NEJM 2009 Online First; 30 June 2009

6. PPACA, accessed at

7. Sox, HC, “Comparative Effectiveness Research: A Progress Report,” Ann Intern Med; online 2 August 2010

8. Lauer, MS, Collins, FS, “Using Science to Improve the Nation’s Health System,” JAMA 2010; 303(21):2182-3

9. Slutsky, JR, et al., “Patient-Centered Comparative Effectiveness Research,” Arch Intern Med 2010; 170(5):403-4

10. Docteur, E, et al., ‘How Will Comparative Effectiveness Research Affect the Quality of Health Care?” RWJF/Urban Institute, February 2010

11. Ghaferi, AA, “Bending the cost curve in the United States; the role of comparative effectiveness research,” Critical Care 2010; 14:168

12. Weinstein, MC, et al., “Comparative Effectiveness and Health Care Spending- Implications for Reform,” NEJM 2010;  362(5):460-5

13. Rich, EC, and Docteur, E, “Politics and Policy of Comparative Effectiveness: Looking Back, Looking Forward,” Mathematica Policy Research, Inc., Issue Brief #1, June 2010

14. Martin, DF, et al., “Identifying and Eliminating the Roadblocks to Comparative Effectiveness Research,” NEJM 2010; Online First, 3 June 2010

15. VanLare, JM, et al., “Five Next Steps for a New National Program for Comparative Effectiveness Research,” NEJM 2010; Online First, 17 February 2010

 16. Conway, PH, et al., “Charting a Path From Comparative Effectiveness Funding to Improved Patient-Centered Care,” JAMA 2010; 303(10):985-6

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