Research & Commentary: Comparative Effectiveness Research

Published April 19, 2011

The American Recovery and Reinvestment Act of 2009 provided $1.1 billion for comparative effectiveness research (CER). The Patient Protection and Affordable Care Act established the Patient-Centered Outcomes Research Institute to set priorities for this research and disseminate its findings to health care decision makers.

Proponents of CER, such as the Institute of Medicine, say the research will help “consumers, clinicians, purchasers, and policy makers … make informed decisions that will improve health care at both the individual and population levels.” Providers of some surgical therapies and manufacturers of some drugs and durable medical goods envision CER as an opportunity to demonstrate the validity and superiority of their procedures and products and thus qualify for reimbursement by the government.

Critics of government promotion of comparative effectiveness research say it will stifle innovation and limit therapies available to patients. Not all patients are in the center of the bell-shaped curve, and therapies that are effective on average may not be best for a particular patient. CER critics contend it will be like the National Institute for Health and Clinical Excellence (NICE) in England, quickly morphing into a cost-effectiveness test that overrides doctors’ medical judgment and patients’ choices and leads to the rationing of care.

As science progresses and we move toward more individually targeted, patient-specific therapies, government health care policy is moving in the opposite direction, to a one-size-fits-all approach likely to be ineffective for most. Government pressure for CER further thwarts progress in health care.

The following references examine comparative effectiveness research policy from multiple perspectives.

Comparative Effectiveness Research: Political Science, Not Medical Science
Heartland Institute Senior Fellow Dr. Richard Dolinar examines many of the problems that comparative effectiveness raises for doctors and patients. He explains, “It will force them to use cheaper treatments because a third-party payer says the two are comparable. It will force them to provide the same therapy for each patient without considering their individual differences.”

Comparative Effectiveness in Health Care Reform: Lessons from Abroad
Helen Evans, Ph.D., a health fellow with the Adam Smith Institute in London, England, writes in this Heritage Foundation paper how comparative effectiveness has harmed the quality of health care in other countries. She writes, “As is clear from the British experience and other international examples, a comparative effectiveness strategy that relies on central planning and coercion would not only be counterproductive in the long run—because it would undermine the incentives for medical innovation—but would also lead to the imposition of cost constraints that would worsen patients’ medical conditions and damage the quality of their lives.”

Comparative Effectiveness Research Pros, Cons
Peter J. Pitts, president of the Center for Medicine in the Public Interest and a former associate commissioner of the U.S. Food and Drug Administration, provides an overview of the pros and cons of comparative effectiveness research. He writes, “comparative effectiveness research (CER) could lead to severe restrictions on the kinds of treatments available to Americans who need medical care.”

The Problems of Comparative Effectiveness Research
Heartland Institute Research Fellow Benjamin Domenech lays out the problems of comparative effectiveness research in this Washington Examiner article. He points out, “A fully deployed CER gives government the power to tilt the playing field in favor of whatever’s cheaper, which can—and I believe will—mean overruling doctors to the detriment of patients.”

A Better Way to Generate and Use Comparative-Effectiveness Research
Michael F. Cannon, the Cato Institute’s director of health policy studies, offers a better way to generate and use comparative effectiveness information. He calls on Congress to “eliminate government activities that suppress private production. Congress should let workers and Medicare enrollees control the money that purchases their health insurance. Further, Congress should require states to recognize other states’ licenses for medical professionals and insurance products.”

Promoting and Using Comparative Research: What Are the Promises and Pitfalls of a New Federal Effort?
Dr. Scott Gottlieb, a resident fellow at the American Enterprise Institute, examines the federal government’s efforts to underwrite and research the comparative effectiveness of drugs and medical devices. He writes, “like many other seductively simple ideas, enthusiasm for comparative effectiveness research (CER) outpaces its practical promise and obscures the downside of having governments take on these sorts of studies and the clinical considerations that go into them.”

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