Comparative effectiveness research

Comparative effectiveness research (CER) is the direct comparison of existing health care interventions to determine which work best for which patients and which pose the greatest benefits and harms. The core question of comparative effectiveness research is which treatment works best, for whom, and under what circumstances.

The Institute of Medicine committee has defined CER as "the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. The purpose of CER is to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels."

Comparative effectiveness research adopts many of the same approaches and methodologies as cost-effectiveness analysis, including the use of incremental cost-effectiveness ratios (ICERs) and quality-adjusted life years (QALYs). An important component of CER is the concept of pragmatic randomised controlled trials. These clinical research trials measure the benefit produced by the treatment in routine clinical practice.

Researchers at the Dartmouth Institute for Health Policy, in addition to the Congressional Budget Office, have documented a large gap in the quality and outcomes and health services being delivered. Unwarranted variation in medical treatment, cost, and outcomes suggests a substantial area for improvement and savings in our health care system. Statistical findings show that "patients in the highest-spending regions of the country receive 60 percent more health services than those in the lowest-spending regions, yet this additional care is not associated with improved outcomes." New models of shared decision making promise to bring greater emphasis to informed patient choice for "preference-sensitive" care, improving quality, safety, and effectiveness of health care by providing both patients and their health care providers with the evidence to assist in informed decision making.

In 2009, $1.1 billion of President Barack Obama's stimulus package was earmarked for CER. There was initial disagreement regarding whether CER will be used to limit patient health care options, or help lower health care costs. Ultimately the bill approved by Senate contains measures to utilize CER as a means for increasing quality while reducing rising costs.

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