What’s at Stake?
Comparative effectiveness research—whereby pharmaceuticals, medical devices, and medical procedures used to treat the same conditions are evaluated for their relative safety and effectiveness—will improve the quality of health care in America. The availability of scientifically valid, objective, comparative information on the most effective treatment options for patients is a critical building block of health care reform. Such knowledge will help doctors and patients make more informed decisions about the best treatments.
Comparative effectiveness research will create more objective medical research that could help providers, families and individuals choose the treatment that is most appropriate for them. Unfortunately, some mistakenly allege that this research will create “socialized medicine” or prevent a doctor from prescribing treatments that are most appropriate for his/her patient. For years, many different entities both inside and outside of government have engaged in comparative-effectiveness research. The Agency for Health Research and Quality (AHRQ) currently performs some comparative effectiveness research; however, the agency has been underfunded and therefore limited in the types and quantity of studies it can conduct.
The Institute of Medicine has pointed out that of the nation’s more than $2 trillion in annual health expenditures, less than 1 percent is invested in addressing the comparative effectiveness of medical treatments, prescription drugs, and so-called “healthy behaviors.” Some health policy analysts have actually concluded that less than half of all medical care currently provided in the United States is supported by evidence.
Without passage of legislation to make comparative effectiveness research possible, our nation will continue to spend billions of dollars on ineffective care. Doctors and patients will be left without the reliable information they need to make good health care decisions.
Under Section 1013 of the Medicare Modernization Act of 2003, the AHRQ is granted the authority to conduct comparative effectiveness research. Historically, AHRQ’s funding has been insufficient to conduct and disseminate enough research to impart significant change within the health care system. However, the recently passed American Recovery and Reinvestment Act included $1.1 billion for comparative effectiveness research.
Simply funding comparative effectiveness research studies through the annual appropriations process is a good first step, but we need to create an independent entity with a stable source of long-term funding that can conduct and disseminate comparative effectiveness research studies. AARP supports the Comparative Effectiveness Research Act of 2008 (introduced in the 110th Congress by Senators Baucus and Conrad), which would create the independent and nonprofit Health Care Comparative Effectiveness Research Institute to conduct comparative effectiveness research and to publicly disseminate the results. The legislation calls for the Institute to be governed by a broad group of stakeholders and to gather public input on establishing research priorities. Equally important is that such an Institute be funded through an all-payer system with a significant and stable source of funding to ensure the continuation of such a valuable investment. The entity will also utilize standard methodologies (something not always practiced with respect to existing research), thus making it easier to draw conclusions based on the research that has been conducted.
Awareness of the need for comparative effectiveness research has been gaining momentum, as shown by the introduction of the Comparative Effectiveness Research Act of 2008, the House-passed provisions in the 2007 CHAMP Act, and inclusion in Senate Finance Committee Chairman Max Baucus’ “Call to Action,” a white paper on health reform. In addition, the recently enacted American Recovery and Reinvestment Act included $1.1 billion for comparative effectiveness funding. AARP believes this critical issue of quality and effectiveness is a fundamental building block of health care reform.