Sunday, August 2, 2009

     

 
 

 

COMPARATIVE EFFECTIVENESS RESEARCH:  A good practice?

 

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While not a new concept, comparative effectiveness research (CER), and the inclusion of $1.1 billion in funds for this research in the American Recovery and Reinvestment Act of 2009 (ARRA), has received a lot of media attention lately.  Proponents argue it has the potential to reduce rising healthcare costs and improve healthcare quality.  Opponents argue that using cost as a factor to assess effectiveness could inhibit a physician’s ability to prescribe costly treatments and provide new therapies.

 

CER is loosely defined as testing the clinical effectiveness of treatment options for a medical condition by comparing similar treatments, competing drug therapies or analyzing different approaches, such as inpatient versus outpatient surgery.  The goal is to provide doctors and patients with evidence to support treatment decisions.

 

In addition to concerns about cost comparison, there are concerns about which populations are included in the research.  In the United States, women and minority groups are not typical participants in clinical trial studies.  What constitutes good practice for CER?  If you use clinical trial data for the research, a large portion of the population is likely excluded. 

 

Since demand for comparison information is greater than resources for conducting additional expensive clinical trials, initiatives are being established to use observational research based on patient follow-up data.  Since minority and non-English speaking populations in the US are growing significantly every year (equivalent to 50% of the population by 2050), special care needs to be taken to use observational data representing these vulnerable populations.

 

Gathering observational data provides faster results but since it is more subjective than a formal clinical trial setting, where that data comes from becomes important. With attention to comparative effectiveness research unlikely to wane in the near future, clear guidelines affecting CER study conduct, evaluation, reporting, and their inclusion of minority and non-English speaking populations, needs to be created to garner the best results. 

 

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