Comparative effectiveness research (CER) has received much attention ever since the Affordable Care Act set a goal of achieving patient-centered, cost-effective care. Comparing healthcare technologies to determine which ones result in improved patient outcomes is not a new concept. However, in light of the requirement that hospitals and healthcare systems provide high-quality patient care in a cost-effective manner, providers will need to better examine the scientific evidence before making spending decisions for healthcare technologies such as medical devices, physician preference items, medical equipment, and drugs.
Even more important, though, is the need for better evidence to assess differing approaches to patient care. That’s where CER comes into play. CER is the robust evaluation of various approaches to the care of patients with certain conditions to determine the impact of those options. CER may compare similar treatments, such as medications, or it may compare different approaches, such as surgery and medical therapy, to determine which option works best for which specific types of patients. Sometimes CER compares only the relative health benefits and outcomes for the treatments in question; in other instances, CER also analyzes the costs associated with each option to determine the costs versus the benefits.
The ultimate purpose of CER is to identify the clinical value and cost benefit of devices, drugs, and interventions, NOT to ration care. (I’ll discuss the demonizing of CER in a subsequent post.) CER can help us determine not only whether a medical technology works and is safe, but how well it compares with other approaches and for which applications it is best used. Where medical devices are concerned, CER goes beyond a simple comparison of purchase price or lifetime costs to operate the devices. It examines whether the specific products actually enhance patient care and improve outcomes.
As Congress—and the stock market’s response—have demonstrated, runaway healthcare costs are not sustainable. We need to generate good scientific evidence and develop evidence-based approaches before we make spending decisions. Beyond that, we must translate the evidence into practice guidelines that will enable us to better manage patients when they need care. And do it cost effectively. Every dollar we spend on healthcare should give us maximum value. Healthcare services need to work, work well, and be safe. If one approach is better than another for a particular set of patients, then we should choose the better one.
I recognize that a paradigm shift to evidence-based decision making will be necessary. Making this paradigm shift will require a number of changes, such as adding evidence evaluation and application to educational curricula, and ensuring open and candid discussion about the need for and the benefits of an evidence-based approach to healthcare delivery, including consideration of cost-effectiveness. It won’t be easy.
Some pundits, physicians, and other stakeholders are already telling us why CER won’t work. I disagree. Only by integrating evidence into practice and policy will we be able to improve the quality and safety of services while reducing ineffective products and practices. The result will be healthier individuals.