Thursday night on NBC nightly news, Dr. Tim Johnson said “we’re paying for treatments that have never been proven to work” presuming we’re wasting dollars on dubious medical innovations. He described this within the context of the Obama administrations’ announcement of Tom Daschle as the new Health Care Czar who may establish an independent health care board isolated from health care lobbying “interests” and prioritizing US government spending. Within this context, it will likely adopt some process of comparative effectiveness to evaluate health care interventions. Stuart Altman recently said, “we need to move aggressively forward to develop the capacity of this country to do effective comparative research…the nation cannot afford healthcare that is not supported by evidence of sufficient benefit”.

But what really is comparative effectiveness? Comparative effectiveness in the context of health is as old as “medicine itself”, an implicit and explicit comparison of one medical technique to another. If the intervention works (i.e., understanding positive and negative impacts on patient outcomes), than one may translate this into “economic effectiveness”, or “cost-effectiveness” metrics. In our quest to assess value of medical interventions based on meaningful clinical outcomes, decision makers are using a number of well-established academic methodological approaches.

Is this new? No.

Through the years, research techniques, programs and processes have been employed evaluating health quality, benefits, costs and risks. Familiar approaches include “outcomes research”, health economics studies, evidence-based medicine (EBM), disease management, randomized clinical outcomes studies, evidence-based practice centers, technology assessments, and the like. Comparative evaluations of medical interventions is a well-established science with universities, global governments (including our own MedCAC and AHRQ), hospitals, pharmacy benefit managers and many other assessment think tanks employing the same approach but under different titles.

So how is the new proposal for a comparative effectiveness, independent government entity going to be different, better, or more comprehensive than any of the processes, programs and studies that medical technology currently undergoes? Will another process to examine technology beyond what currently exists provide the solution to unbridled health care spending?

Is it truly possible that investors or manufacturers of new innovations don’t consider the impact on patient benefit and costs before investing millions in commercialization?

Given the wide-spread use of assessment processes already employed, the comparative effectiveness initiatives proposed could be a tremendous benefit to manufacturers, physicians, and policy decision makers.

One hopes that the new government comparative effectiveness institute is fully funded to support the wide-array of comprehensive studies required to do this right. It is essential to continue to gather information comparing interventions paying only for those “worth the money”.

But without a serious fix of the payment systems that drive the use of new innovations (e.g., physician payment reform, rewarding acute care services over home, personalized, or preventative care), policy makers will have failed again at “saving money”.

To truly make an impact on health care costs, comparative effectiveness research must be the first step and complimentary effort to the vexing and impactful issues that truly have an enormous impact on spiraling costs but are more difficult and politically unpopular to solve.

This entry was posted on Sunday, December 14th, 2008 at 2:28 pm and is filed under Cost, Coverage Policy, Insurance, Policy, Politics. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.