Comparative Effectiveness

What is comparative effectiveness research? If you need a reminder: comparative effectiveness means comparing two or more treatments for the same health problem to see which one works best for patients. The question has popped up quite a bit since comparative effectiveness research showed up in the economic stimulus package alongside other common sense health reforms, such as health IT adoption. Comparative effectiveness is about giving doctors and patients more information and facts for decision-making, not about taking away their autonomy.

Nearly a third of health spending provides no added clinical value to patients. Half or less of what physicians do is backed up with valid scientific evidence. On average, patients get the recommended care just over half the time.

For health policy wonks, these facts are well accepted and treated as crucial components to the case for health reform. But for average Americans, many of these figures would come as a surprise according to recent polling done by the Campaign for Effective Patient Care, in conjunction with Lake Research Partners.

The findings are compiled in a report written by our colleague, Shannon Brownlee, a fellow at New America and the author of the excellent book on our health care system: Overtreated.

The poll surveyed 800 Californians who voted in the last year's election. A brief summary of the findings is available here and toplines are available here. Below are some of the highlights that caught our attention:

Leif Wellington Haase, the director of New America's California Program and the author of "A New Deal for Health: How to Cover Everyone and Get Medical Costs Under Control," shares his thoughts in this Sunday's New York Times Magazine article on health care spending and rationing.

So long as U.S. medical costs have gone up rapidly, and in particular since the early 1970s, policy analysts, health economists, and medical ethicists have debated the balance between extending an individual life and paying, in effect, for better health for the many. The proliferation of medical technologies, some of which can extend a lifespan by a limited amount but at an enormous marginal cost, has revived this discussion.

When it comes to health benefits, what is most important to you? Are there certain benefits that are absolutely necessary? Are there some that you could do without?

That's exactly what the Center for Healthcare Decisions wanted to know. They recently released the report "What Matters Most: Californians' Priorities for Healthcare Coverage."

Understanding public priorities for health care benefits is a big deal for lawmakers. Currently, Congress is charging ahead toward health care reform, and figuring out how to design minimum benefit standards for health plans is part of their agenda. A minimum benefits package will make sure Americans have insurance that means something, that they will get the care they need, not a bunch of runarounds and denials of coverage. One way lawmakers can connect with American values on health care is to understand what the American people want in their health benefit package.

When she spoke to us at the Health CEOs for Health Reform event recently, Merck's Senior Director of Public Policy, Jane Horvath, presented her response to two very important questions. Why does Merck, one of the world's largest pharmaceutical companies, believe that delivery system reforms are possible? And what has Merck done that demonstrates that change is possible?

To learn about Merck's pilot plan to promote value and quality in health care, check out the video below, or keep reading.

Earlier this week, we discussed the Federal Coordinating Council for Comparative Effectiveness Research's recommendations for comparative effectiveness research. Recently, an Institute of Medicine panel released a similar report, which offers a comprehensive list of 100 health issues ranked according to priority.

Comparative effectiveness research gives doctors and patients access to verified, scientific information on best treatments that they otherwise could only get through their best guesswork.

Remember that $1.1 billion in the economic stimulus package (aka the American Recovery and Reinvestment Act) dedicated to comparative effectiveness research? Though many of us have had a lot on our minds lately with health care on the Hill, others have stayed focused on how to best use those stimulus funds. This week, the Federal Coordinating Council for Comparative Effectiveness Research, an independent advisory committee, released recommendations.

Comparative effectiveness research provides insight into the best treatments based on real world data. The Council's goal is to create a solid foundation of research that both patients and clinicians could use to inform their treatment decisions.

Health care is a large, diverse field, so the Council also had to come up with a framework for prioritizing research areas. To be considered, a research topic has to meet certain criteria:

Hundreds of thousands of patients undergo cancer treatment each year, using all sorts of combinations of drugs and treatments and therapies. Not all are in clinical trials—but many of them have something to teach us. We linked to Gooznews touching on this topic a few months ago. Now Merrill Goozner has a longer analysis at Science Progress of how, in part because of advances in health IT, we could tap this untapped pool of knowledge:

A redrawn battle plan—one that focuses on turning the treatment system into a research and learning system that can teach oncologists the best use of the weapons they already have—is long overdue...

…Many of the nation’s 30,000 oncologists are engaged in what could be described as an unobserved and uncontrolled science experiment, especially when it comes to treating the 560,000 Americans who die each year from the more than 100 forms of the disease. As these patients’ cancers advance, their physicians try regimens they read about in journals or hear about from colleagues. The outcomes are never gathered. The data is never analyzed. And the findings are never disseminated.’

A piece in Thursday's New York Times suggests that the battle lines are being drawn (again) on comparative effective research (CER). For the New England Journal of Medicine, it's not even a debate.The nation's preeminent medical journal has three articles published this week that come out strongly in favor of comparative effectiveness research.

Addressing concerns that CER creates barriers to medical progress, Alan M. Garber and Sean R. Tunis argue, in fact the opposite is true. While not a panacea, CER is "key to individualized care and innovation, not a threat." Noting that doctors often lack information on what works best for who, Garber and Tunis assert:

[F]ar from impeding personalized medicine, CER offers a way to hasten the discovery of the best approaches to personalization, providing more and better information with which to craft a management strategy for each individual patient.

Well if the Republicans hadn't figured out that the American people are clamoring for health reform, their message guru Frank Luntz is back on the scene to remind them. The Politico's Mike Allen today has a piece on the confidential 26-page report to Capitol Hill Republicans coaching them on how to use language to stop "the Washington takeover of Health Care." The Politico article doesn't specify who asked Luntz to do this or who paid, but it's an interesting read—both about how conservatives perceive health reform and how large swathes of the public is demanding change. We especially liked the part about how health care reform is "inevitable."

Allen writes: