Comparative Effectiveness Research: Evidence, Medicine, and Policy

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An example may help to illustrate the difference between the two methods.

Percutaneous coronary intervention PCI is a technique in which narrowed or blocked blood vessels of the heart are opened by inserting an inflatable balloon and may then be kept open by introducing a coronary stent. PCI dramatically improves survival after a heart attack and compares favorably with drug therapy on both a comparative and cost effectiveness basis.

Comparative Effectiveness Research

When PCI is used for patients with stable angina, however, the health benefits are only slightly better than with drug therapy, while the costs are much greater. Economists are naturally inclined towards cost effectiveness because of its consideration of costs as well as benefits. Using cost effectiveness to determine our level of health spending would ensure that we would spend just to the point where our resources would generate greater value if expended elsewhere.

However, the application of this criterion would mean that some services with positive health benefits, like PCI for patients with angina, would not be covered by insurance.

Comparative Effectiveness Research

While sympathetic to the economist's point of view, the authors argue that comparative effectiveness research "still holds promise. Indeed, when rationing was tried in the Medicaid program in Oregon in the s, it was met with resistance and the experiment ultimately failed.

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In the health care law, Congress prohibited the use of "a dollars-per-quality adjusted life year or similar measure Second, there is little or no evidence of the comparative effectiveness of treatments for many conditions, since most studies compare a given treatment to a placebo rather than head-to-head with competing treatments. Even in the absence of any explicit consideration of costs, comparative effectiveness studies add to the public knowledge base about what works in health care and what does not, and may lead to cost savings.


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For example, a recent study found that patients with terminal lung cancer who were randomly assigned to receive early palliative care rather than standard chemotherapy had better quality of life, longer survival, and lower costs. Critics of comparative effectiveness research point to several challenges.

Carol M. Ashton and Nelda P. Wray

The first is patient heterogeneity. While a study may establish that treatment A yields greater health benefits than treatment B for the typical patient, there may be subpopulations who fare better with treatment B. In theory this problem can be overcome by conducting studies of relevant subpopulations, but cost and difficulties in identifying which groups to study may be difficult obstacles in practice.

As an alternative, information from comparative effectiveness studies could be used to "nudge" patients away from less effective therapies for example, by imposing higher co-payments while maintaining access for those who truly need it.

Dr. Hlatky on comparative effectiveness research

A related issue is heterogeneity in provider skill. The results of a study conducted at a teaching hospital may not apply to all providers, for example if there are economies of scale, learning by doing, or spillovers to other therapies.


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  3. What is CER?.
  4. A final concern is the cost of comparative effectiveness research. The core question of comparative effectiveness research is which treatment works best, for whom, and under what circumstances. Center for Medical Technology Policy.

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    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. Comparative effectiveness usually compares two or more types of treatment, such as different drugs, for the same disease. Comparative effectiveness also can compare types of surgery or other kinds of medical procedures and tests. The results often are summarized in a systematic review. Skip to main content.


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