A Good Summary on Comparative Effectiveness Research

Comparative effectiveness research has been held up as one of the promising avenues for reducing health spending growth while maintaining quality.  The Rand Corporation has put together a good summary of a number of issues relating to this research.  (Rand Material)  As the summary points out, there are few studies on the use of comparative effectiveness research and its effects on health outcomes or costs.  In regard to the potential for cost savings, three things are needed:  clear evidence on the relative effectiveness of treatments; identification of a clinically equivalent or superior treatment; and use of that information by providers and patients.    Any cost savings would have to be larger than the costs of comparative effectiveness research for there to be net savings.   Research using clinical trials can be very expensive, typically millions, if not tens of millions of dollars.   Other types of research, retrospective claims data reviews, for example, is much less expensive.  One survey suggested that about 75% of the time comparative effectiveness research shows that a treatment confers a benefit and costs more than the current treatments.  Not a recipe for huge cost savings, but if even 20-25% of the studies led to less spending that would likely be better than having no comparative effectiveness research results available. 

The summary also discusses the need to create incentives so that the results of the research actually get used.  These might be financial incentives or disincentives for providers or for consumers.  If a treatment leads to better clinical outcomes, encouraging its spread might lead to overall health status improvements.  Comparative effectiveness research may also help improve patient satisfaction, particularly when used as part of a joint decision-making process with the patient’s physician.   As with many touted reform opportunities, however, the Rand material leaves the impression that there is significant potential benefit, at least in health improvement, from comparative effectiveness research, but it will be a long and complex process to routinize both the research and the use of its results.