Cost Effectiveness / Comparative Effectiveness: Rationing or Priority Setting?

“My question . . . is how can we get our policy makers and legislatures . . . to better use data . . . to inform their decisions?”

 

A qualitative study addressing the controversial topic of cost-effectiveness analysis (CEA) – also known as comparative effectiveness research (CER) – sheds light on the perspective of health care decision makers. Researchers conducted focus groups among 58 executives and employees from various California health care organizations (Kaiser-Permanente, Department of Health Services, Pacific Business Group on Health, Blue Shield of California, Integrated Healthcare Association, Department of Managed Health Care).

The authors sought to determine the self-reported knowledge level about cost-effectiveness analysis and attitudes about such science. Participants were skeptical of some research; 38 of 45 respondents felt that when cost-effectiveness data was sponsored by the manufacturer such studies would be biased. 32 of 45 respondents felt that cost-effectiveness data would not be relevant to the short-term (often two years or less) time horizon of their employers. Two-thirds of respondents felt that their health plans might open themselves to malpractice litigation if cost-effectiveness data were used to make coverage determinations. This assumption represents a major barrier to increased adoption of this technique even if valid data became available. Yet, 52 of 58 felt that CEA should be used for Medicare coverage decisions; 43 of 58 felt similarly for private insurers.

Several related “Perspectives” in the May 7, 2009 issue of the New England Journal of Medicine focus on comparative effectiveness research. Each of them express support for the concept which recently received a $1.1 billion funding boost from the American Recovery and Reinvestment Act of 2009. Prior to this, comparative effectiveness research (funded mainly through the Agency for Healthcare Research and Quality’s “Effective Health Care Program”) received about one-tenth of 1 percent the money spent for research at the National Institutes of Health. This certainly will boost the capacity of this small program, which as of this writing only has 11 medical topics available for comparison.

 

Commentary:
The money allocated in the American Recovery and Reinvestment Act of 2009 has already sparked a firestorm. On one side, Conservatives for Patients’ Rights and other like-minded organizations and individuals argue that comparative effectiveness research will serve to deny a doctor the ability to care for their patients. The other end of spectrum believes comparative effectiveness will foster more intelligent and equitable use of scarce medical resources.
We largely do not know what will happen once data pours in from comparative studies. Very few medical topics are adequately researched now to determine not only the best, but also the most cost effective, treatments. Even still, health care providers often base decisions outside of the science of medicine, relying on the art of medical practice. However, Americans and their doctors will never have the opportunity to improve the efficiency of health care, decrease health care costs, or know the preferred treatment strategies for patients if ideologues trump the debate over comparative effectiveness.

Health Economics, Policy, and Law (Feb 9 2009) Epub ahead of print.

 

by
Cedric K. Dark, MD, MPH

One Reply to “Cost Effectiveness / Comparative Effectiveness: Rationing or Priority Setting?”

Comments are closed.