Lack of coordination in comparative effectiveness research risks redundancy and unnecessary cost

In order to reap the potential rewards of comparative effectiveness research (CER), policymakers and researchers need a better understanding of the current capacity for conducting these studies in the United States, how best to design them, and the potential role of cost in evaluating treatments, according to two new reports from AcademyHealth.

In "A First Look at the Volume and Cost of Comparative Effectiveness Research in the United States," Erin Holve, Ph.D., and Patricia Pittman, Ph.D, reviewed the types of studies and treatments that have historically been the focus of CER as well as the respective costs of those study designs. The review—which included a focus group with researchers to identify key study types; a scan of trials in the government databases clinicaltrials.gov and HSRProj; and interviews with researchers and research funders—found a substantial volume of ongoing research but little coordination, widely variable costs within and between study designs, and significant potential to duplicate efforts.

"Our findings are the first structured review of how much comparative effectiveness research is ongoing, and at what cost," says Holve. "But we acknowledge that it is currently impossible to identify the full universe of CER given the limitations of the existing databases and the lack of a coordinating entity."

The findings underscore the need for developing a national research agenda that is both transparent and inclusive of the many stakeholders currently in this field. According to the report, coordination would reduce long term costs by reducing or eliminating overlapping work and improving overall understanding of the most cost efficient study designs.

In a related work, "Incorporating Costs into Comparative Effectiveness Research," Michael Gluck, Ph.D. reviews the differing perspectives on cost analysis and its potential role in CER. According to the brief, a certain level of value consideration is inherent in our decisions about care, but the degree to which a formal cost effectiveness analysis is included in the evaluation of different treatments remains hotly disputed.

"While not everyone agrees with the principle, policymakers in most other industrialized countries and some U.S. payers already consider the relative value of health care services when making decisions about which ones to cover or how much to pay for them,"
says Gluck. "Our paper provides policymakers a brief, balanced review of the differing perspectives on this issue."

Source: AcademyHealth