Category Archives: Comparative Effectiveness

comparative effectiveness about clinical and economic outcomes, i.e. value of healthcare services and products

Comparative Effectiveness in Healthcare Session at AAAS Meeting

Posted on by
1

I attended the annual meeting of the American Association for the Advancement of Science today to hear a session titled “Health Economic Evaluations of Medical Technologies: Is the Cost Worth the Cure?”  The topic of this session was really about comparative effectiveness of medical interventions – particularly pharmaceuticals. The panel was a substantial group of physicians and health services researchers/regulators:

  • Milton C. Weinstein, Harvard School of Public Health
  • Michael F. Drummond, University of York, United Kingdom & NICE (National Institute for Health and Clinical Excellence)
  • Jeffrey Kelman, Chief Medical Officer at CMS
  • Marc Berger, Eli Lilly
  • Tracy A. Lieu, Harvard Medical School and Harvard Pilgrim Health Care

The most impressive thing about this 3 hour session was that at a meeting with thousands of attendees, there were 12-15 people in this session.  Clearly the organizers had expected more, since the room had space for a couple of hundred.

Despite the small audience, the panel gave interesting – if not too in-depth -  presentations which at times delved into jargon about programs such as Medicare Part D, and unfortunately didn’t engage in speculation about the future of comparative effectiveness for decision making about the allocation of resources for healthcare services or research.

What was clear, is that (as I mentioned in an earlier post), comparative effectiveness is something here to stay.  The question remains to see how it will be used in the future by payers (particularly in the US), and how this will effect the quality of care, and the direction and intensity of research activities.

Technology and Health Care Costs

Posted on by
Reply

Peter Orszag, the Director of the Congressional Budget Office (CBO), recently testified before the Senate Budget Committee about increasing health care costs. One of his conclusions was that “the most important factor driving the long-term growth of health care costs has been the emergence, adoption, and widespread diffusion of new medical technologies and services by the U.S. health care system.”

His testimony concludes that by using “comparative effectiveness” research to “generate more information about the relative effectiveness of medical treatments and changing the incentives for providers and consumers,” would create a situation where “savings are possible without a substantial loss of clinical value.”

While this all sounds good in principle, the challenge obviously is to make the information useful, reliable and accessible. And, of course, as the testimony notes, “To affect medical treatment and reduce health care spending, the result of comparative effectiveness analyses would ultimately have to change the behavior of doctors and patients — that is, to get them to use fewer services or less intensive and less expensive services…”

CBO has been greatly increased their health care staff, created a Panel of Health Advisers last fall, and the comparative effectiveness issue was not a tossed-in part of the CBO testimony — CBO had a separate report on this topic last fall, and Director Orszag will be part of a panel on the topic at the Institute of Medicine on February 21st.

Comparative effectiveness seems to be the latest in a series of attempts at transforming health care operations in the US that can be traced back several decades, and includes: Consumer Directed Health Plans, Managed Competition, and Managed Care – particularly HMOs.

The question is, will comparative effectiveness really change clinical practice to alter the course of expected increases in health care spending without sacrificing quality?

What do you think?