Research to compare the effectiveness of different medical treatments of the same conditions is on the upswing, due largely to significant increases in federal funding and the creation of a new public-private institute to steer those dollars.
Some contend that comparative effectiveness research is the best way to test and understand what treatments work best for a majority of patients, potentially cutting waste in the health care system. However, others warn that patient populations are too complex to be tested comparatively and that holding patients to uniform standards of care could limit their ability to obtain coverage for unique reactions or conditions.
In large part the debate will be settled by the 21 members of the Patient-Centered Outcomes Research Institute which replaces the Federal Coordinating Council for Comparative Effectiveness Research under Health Care Reform. Members of this institute will be appointed by the Comptroller General at the end of this month and will set the agenda for federal research efforts. However, the Patient Protection and Affordable Care Act prohibits this group from issuing practice guidelines or making recommendations for coverage.
The research institute will receive baseline funding of $10 million in fiscal year 2010, $50 million in fiscal 2011 and $150 million each year from fiscal 2012 through fiscal 2019. The body will also receive substantial funding from fees on health insurance plans and transfers from the Medicare trust fund.
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There will always be tension between what approaches work best for a population of patients and what will work best for an individual patient.
Our current system is biased toward providing all possible care to a patient rather than what is the most effective approach, given the circumstances of the disease the patient has. This is a very costly bias that we all pay for through higher insurance premiums and hospital costs. If we are happy paying for this extravagance, then we might not need comparative effectiveness research.
But, I would contend that, putting cost aside, we still need comparative effectiveness research to guide our discussions with our patients in deciding a given course of treatment. How can we practice without knowing that, in strong head-to-head scientific studies, which treatment option gives the best result 9 out of ten times, or 999 out of a thousand times?
I favor the development of the Patient-centered Outcomes Research Institute, provided 1. it focuses on medical outcomes and not financial outcomes, 2. it has a fair appeals process, 3. it has strong representation by physician researchers and practicing physicians.
Chuck Willson MD