Patient Care – Not Cost – Must be Focus of Future CER

As the nation continues to focus on the health care debate, PIPC is maintaining its commitment to ensuring patient care – not cost – is the driving force behind new efforts to implement comparative effectiveness research (CER).

The latest August edition of U.S. News and World Report highlights CER in a cover story discussing the future of medicine. Dr. Bernadine Healy, former head of the NIH and the magazine’s health editor, raises a valid concern that CER could be misapplied. "Cost considerations based on averages will be factored into medical practice guidelines, functioning as an invisible hand that puts a brake on health expenditures even though they benefit certain people," Dr. Healy writes.

While CER conducted effectively could result in cost savings for our health system, cutting expenditures cannot be the main goal of this research. CER must focus on patient needs, account for differences among different patient populations and avoid applying research results in ways that will overlook the differences beteween individuals.

H.R. 2502, Rep. Kurt Schrader’s (D-OR) Comparative Effectiveness Research Act of 2009, achieves patient-centered CER by establishing an institute focused on improved quality of care through evidence-based clinical research, and the consequent sharing of that research with patients and providers. The bill states, “The purpose of the Institute is to improve health care delivered to individuals in the United States by advancing the quality and thoroughness of evidence concerning the manner in which diseases, disorders, and other health conditions can effectively and appropriately be prevented, diagnosed, treated, and managed clinically through research and evidence synthesis, and the dissemination of research findings…”

Moreover, H.R. 2502 establishes clear criteria and procedures for setting research priorities. In addition, the bill stipulates that study designs must “take into account the potential for differences in effectiveness…with various subpopulations, such as racial and ethnic minorities, women, different age groups, and individuals with different comorbidities.” Finally, Rep. Schrader's bill includes a provision to ensure the institute’s reports will not be used “to prevent the physician and patient to ultimately determine what is best for the patient involved given the individual circumstances of different patients”.

This type of CER framework will help address the concerns raised by Dr. Healy by avoiding a “one-size-fits-all” research approach focused on cost containment. PIPC continues to urge the Congress to include CER provisions like Rep. Schrader’s legislation in any health care reform package.

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Patient Care – Not Cost – Must be Focus of Future CER