Heavy Investment in CER will not Transform the US Healthcare System

Andrea Charles

The US government's heavy investment in comparative effectiveness research (CER) will not transform the healthcare system, due to the large numbers of uninsured Americans who need to be absorbed into the system. 

Integrating the uninsured

In a recent review Comparative Effectiveness Research: A Progress Report, Dr. Harold C. Sox, former editor of the Annals of Internal Medicine said: "Comparative effectiveness research does not address the millions of uninsured Americans, who need to be integrated in the health care system. In the next decade, the United States must absorb 32 million currently uninsured people into the health care system while simultaneously improving the quality of care and slowing cost increases. These accomplishments will require a transformation of U.S. health care.”

Government backs CER to improve outcomes

Comparative effectiveness research compares the benefits and the risks of diagnostic tests and treatments against each other, to enable healthcare providers, payers and patients to make the best health care decisions and improve outcomes.

In 2009 the American Recovery and Reinvestment Act (ARRA) allocated $1.1 billion of funding for comparative effectiveness research as part of its plan to transform the U.S. healthcare system. The fund was divided between 3 agencies, The Agency for Healthcare Research and Quality received $300 million, the National Institutes of Health received $400 million, and the same amount was given to the Office of the Secretary of the Department of Health and Human Services. To coordinate research and guide the investment a Federal Coordinating Council for Comparative Effectiveness Research was formed.

In public announcement of the appointed council members, HHS Spokeswoman Jenny Backus said: “Comparative effectiveness research can improve care for all Americans and is an important element of President Obama’s health reform plan.”

Tackling the deficit

According to the World Health Organisation, the U.S. healthcare system ranks 37th among the healthcare systems of 200 countries, and has one of the highest healthcare expenditures in the world. This accounted to 17.5% of its GDP (2009) as compared to an average of 8% to 9% in the Organisation for Economic Co-operation and Development (OECD) countries. With limited resources in the current economic climate and rising health care costs, investing in CER is seen as one way of tackling the deficit.

The US government acknowledges that if ways are not found to reduce the deficit, the economic health of America is at stake. Since federal legislation has launched CER into the limelight. Sox said that the federal agenices have spent the majority of the funding quickly and wisely.

“President Obama sees ever-rising health care costs as a principal threat to the nation's fiscal solvency and believes that research can help to solve the problem. Because he has taken the first steps to test this hypothesis, the immediate future of CER looks bright,” said Sox.

Cost-effectiveness going one step further

Dr. Milton C. Weinstein, Henry J. Kaiser Professor and Director of the Program on Economic Evaluation of Medical Technology at the Harvard School of Public Health said in a Medscape One-on-One: Comparative Effectiveness: “An important feature of comparative effectiveness research is that it is quantitative. So, in addition to assessing whether one approach is better than another, one tries to ask the question, "How much better is one approach over another?"

Comparative effectiveness research may focus only on the clinical benefit of a particular drug or surgical intervention, but can also look at the cost-effectiveness of treatment.

“Cost-effectiveness can be thought of as a type of comparative effectiveness research that goes a step further. In addition to evaluating the comparative health outcomes of alternative approaches to a condition, it also looks at the comparative costs, with the idea that if there are interventions that are underutilised but have very good value and cost relatively little and produce large improvements in outcome, resources could be channelled to them and possibly taken away from other interventions that are either totally ineffective or may be effective, but only very slightly so, and at a very high price,” said Weinstein.

Long-term future for CER unclear

It will be a while before we can measure the direct results of CER funding and whether it has it has done its part to improve health outcomes and reduce healthcare costs. Sox warns that it is not the magic solution:  “Even if it succeeds in providing clearer guidance on what works best and in whom, CER could still become the scapegoat for failure to achieve the larger goals of health care reform,”said Sox.