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Jonathan Moreno and Ruth Faden Discuss Comparative Effectiveness Research

SOURCE: AP/Nati Harnik It’s the very simple health care concept with the very fancy name. Comparative effectiveness research examines the benefits of different procedures used to treat the same illness, allowing health care providers to make the best decisions about options for patients.
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Jonathan Moreno and Ruth Faden Discuss Comparative Effectiveness Research

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Comparative effectiveness research examines different procedures used to treat the same illness and helps determine what works. Much current research simply looks at different medical procedures and compares them to doing nothing. As Center for American Progress Senior Health Policy Analyst Ellen-Marie Whelan explains in a recent “Ask the Expert” video from CAP, some findings indicate that up to a third of the treatments offered in American medicine are not evidence-based. That’s not just a bad way to deliver health care; it’s unnecessarily expensive. But the American Recovery and Reinvestment Act allocates more than $1 billion to ramp up work in comparative effectiveness research.

These new studies will also allow health care providers to make the best decisions about the range of available options for treating patients. Without them, providers may have to rely on information from a drug maker or medical device company that has a financial interest in promoting a particular remedy. Comparative effectiveness research, Ruth Faden explains, “Is a very simple concept with a very fancy term.”

Professor Faden is the executive director of the Johns Hopkins Berman Institute of Bioethics and a Philip Franklin Wagley Professor in Biomedical Ethics at Johns Hopkins University, and she discusses the issue—its basic goals, benefits, and how the United Kingdom uses it in its country’s health system—with CAP senior fellow Jonathan D. Moreno in this new Science Progress podcast. To listen, see the audio player in the sidebar, download the mp3, or subscribe via iTunes.

The basic idea behind the research is to form a direct comparison of existing interventions for one illness—which could include different diagnostic techniques, courses of therapy, medications, and surgeries, as Faden said in her discussion with Moreno. The comparison helps researchers determine which treatments produce the best outcomes for different groups of patients. “Part of the trick is trying to figure out what works for whom. Clearly medicine doesn’t work in a one-size-fits-all frame of mind,” Faden said.

She also points out that comparative effectiveness is distinct from cost effectiveness. Cost effectiveness research attempts to determine the value derived from money invested in an intervention and is not necessarily coupled with comparative effectiveness research. While cost effectiveness aims solely to reduce costs, comparative effectiveness aims to decrease the number of mistreated patients as well as the number of patients who take longer to rehabilitate with treatment A when they could have recovered sooner with treatment B, Faden explained.

“We have to acknowledge that sometimes people go into the hospital and they get set back rather than improved in terms of their health. In some cases that’s because of accidents or errors; in other cases that’s because we just don’t know that something’s going to be harmful for a particular kind of patient. We expect fewer people to be harmed by the medical care they receive,” Faden said. In a broader sense, using this research will improve the quality of health care and decrease costs, as fewer patients will require multiple treatments for the same illness.

One example of how comparative effectiveness research has already proven useful is in the case of the common blood thinner drug, warfarin. Research indicated that depending on a heart patient’s age, one approach to treatment with the drug was more effective than another. This was important because improper dosing of the blood thinner poses serious risks. “If you didn’t aggregate by age or even by gender, then you wouldn’t know which approach would be best for which patient,” Faden said, referring to the warfarin dosing studies.

She also hopes that the information from comparative effectiveness research will be available to patients, especially as they get more involved in their medical decisions. Moreno and Faden co-authored an op-ed on the issue last month in the Baltimore Sun. They highlighted the power of the research: “Comparative effectiveness would allow patients and doctors to make decisions together based on the best possible scientific evidence, giving patients real choices based on solid information. An uninformed choice is like no choice at all.”

Researchers may take two different approaches to investigating evidence-based medicine. They can generate new data to create the direct comparisons, or they could synthesize groups of existing data on intervention use, Faden said. Both options are expensive, but designing new studies is especially costly. Although the $1 billion set aside in the ARRA may seem like a large amount of money, the research is necessary since “the payoff is tremendous,” Faden said. She continued: “Right now it’s sort of the orphan of clinical and biomedical research because it is so practical.”

While the United States is getting its bearings in comparative effectiveness research, the approach is already in motion in the U.K.’s National Institute for Clinical Excellence. NICE is connected to the National Health Service, the U.K.’s health care system. The goal of NICE is to establish values for investments made to maximize health outcomes, Faden explained. The institute strives to unify practice patterns that vary between England and Wales, and its research identifies the most effective treatments to help determine which drugs should be covered by the NHS’s universal entitlement program. Faden pointed out that despite the appeal of reducing health costs with comparative effectiveness research, NICE was partly established to help increase the access to more expensive treatments that were not necessarily available to all citizens and improve overall health and clinical practices in the U.K. One aspect of the NICE programs that people do not appreciate, she explained, “is that it was expressly set up to increase the uptake of certain expensive interventions in the U.K., particularly cancer drugs.”

Faden and Moreno forecast that the United States will be see an increase in comparative effectiveness research within the next couple of years, and that we should expect to know more about the efficacy of interventions we currently use in about five years.

Jonathan Moreno hosts this podcast; Science Progress intern Vivian Cheng produced it for the web.

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