Lumetra Healthcare Solutions

In the August 2009 issue of LQI, Mark Elson, PhD, a Lumetra manager, discussed the concept of Comparative Effectiveness Research and the federal government’s “massive investment in research to impact clinical decision-making and care delivery processes.”  Even before CER was funded by the American Recovery and Reinvestment Act of 2009 and became a feature of several healthcare reform proposals, words of support and pronouncements of opposition have flooded the literature.

The American College of Physicians supports CER as long as the research included cost-effectiveness data. Gail Wilensky, PhD, formerly the Administrator of the Health Care Financing Administration (now CMS), wrote an editorial in the same issue of the Annals of Internal Medicine imploring that any cost-effectiveness information be kept separate from “comparative clinical effectiveness information.”

And last month, Newt Gingrich, former speaker of the U.S. House of Representatives, wrote the following about CER: “The road to dehumanizing, bureaucratic health care rationing begins in the United States with something called comparative effectiveness research (CER). It sounds completely innocent. In practice, CER means comparing different treatments for diseases to see which works best. And what doctor or patient would object to that, right? The problem is that, in the context of a government-run health care system, comparative effectiveness research becomes a way to find a cheaper, one-size-fits-all approach to medicine that will limit health care choices for patients.”

Most of the arguments put forth by the critics of CER and any companion cost effectiveness information were addressed in an interview with Donald Berwick, MD, president and CEO of the Institute for Healthcare Improvement, in the June 2009 issue of Biotechnology Healthcare. In it he recommends three levels of CER: (1) a “simple evaluation of effect,” (2) “comparative effectiveness,” and (3) “an analysis of cost-effectiveness.”

In the meantime, the Agency for Healthcare Research and Quality (AHRQ) announced that it anticipates publishing grant and contract solicitations to support new CER projects, beginning this fall, with funding to commence next spring. Earlier this year Newsweek reported that a 2004 study revealed that 10 million women lacking a cervix got Pap tests. If Comparative Effectiveness Research can minimize such ineffective practices, perhaps it can help mitigate the costs of our healthcare system.