Should Medicare Use Comparative Effectiveness Research?

With the passage of health reform legislation, the U.S. has taken perhaps its most significant step toward formulating national health policy based on the comparative effectiveness of new medical interventions.  Comparative effectiveness evaluates the impact of different treatment options for a given medical condition in a particular set of patients and identifies which option, if any, elicits the best outcomes.  It can be used to compare similar treatments, such as competing drugs, or it can be used to evaluate different treatment approaches, such as surgery and drug therapy.  When cost is factored into the equation, comparative effectiveness may identify the best treatment outcomes with the lowest possible cost.  In other words, the goal of comparative effectiveness is to identify the “most bang for the health care buck.”
When used to make coverage decisions, this analytic technique could lower our national health care costs.  In fact, according to researchers who spoke at last week’s briefing sponsored by the journal Health Affairs, comparative effectiveness research, or “CER,” could yield billions of dollars in savings without threatening patient choice.
According to Steven Pearson, president of the Institute for Clinical and Economic Review, Harvard Medical School, and Peter B. Bach, an attending physician at Memorial Sloan-Kettering Cancer Center, using CER could help the Medicare program “shift to a more sustainable path.”   In their article, Pearson and Bach offer a payment model under which Medicare would pay more for interventions that research had demonstrated provided superior results for patients. When two interventions demonstrate comparable clinical effectiveness, Medicare would pay the same amount for both.  “The time is ripe for Medicare to use comparative effectiveness research to reach a new paradigm, which would include equal payments for services that provide equivalent results,” they said.  Bronwyn Mixter, Using CER to Set Medicare Payments  Could Save Billions, Researchers Say, BNA’s Health Care Daily Report, Oct. 6, 2010. (NOTE: Registration is required to view this content).
Some have cautioned that comparative effectiveness will result in unintended consequences that may outweigh its benefits.  It could, for example, significantly expand  companies’ research and development budgets which, in turn, could stifle innovation in pharmaceuticals and medical devices.  And, there are challenges to the model proposed by Pearson and Bach. For one thing, this would probably require new legislation, and to the extent comparative effectiveness results – or could result –  in rationing of health care expenditures or diminishing patient choice, it will undoubtedly be a controversial policy choice.
The October 5 Health Affairs briefing highlights the most recent issue of the journal, which is devoted entirely to issues in comparative effectiveness research.