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Report Bolsters Push for Comparative Effectiveness Center

October 8, 2009
Throughout the tumultuous debate over health care reform, employers have strongly supported creating a national center that would help determine which medical drugs, devices and procedures are most effective, saying it would improve care and reduce unnecessary costs.

Now they may finally have some research to fend off claims from opponents who say that creating a Center for Comparative Effectiveness would lead to rationing life-saving medicine to those who would need it most.

Republicans opposed to Democratic health care reforms, along with drug and device makers, have tried to limit the use of so-called comparative effectiveness research and have argued against creating a national center for such studies.

Comparative effectiveness research evaluates different drugs, devices and treatments to determine which are most effective. The information is often used to decide what is covered by health insurance.

Such research is less widespread in the U.S. than in other countries.

Opponents say the research, which received $1.1 billion in funding in the federal stimulus plan earlier this year, would eventually be used by bureaucrats to deny care to people based on cost and a person’s age. They often point to Britain’s nationalized health system as proof that the people are denied life-sustaining care.
 
However, a study published Wednesday, October 7, in the Journal of the American Medical Association showed such claims to be suspect. Britain, the study notes, actually pays for nearly all the drugs that are reviewed for comparative effectiveness, though sometimes only in very limited circumstances.

The study on how different countries use comparative effectiveness research shows that Britain approves more drugs than Australia and Canada. Britain’s National Institute for Health and Clinical Excellence approved 87.4 percent of the drugs it reviewed, either for general use or for a specific subset of patients.

The research could help employers and legislators in their quest to include the creation of a similar Center for Comparative Effectiveness in the U.S. in current health reform legislation.

“This research provides a counterargument to those who are enemies of [comparative effectiveness research] right now,” said Helen Darling, president of the National Business Group on Health.

That counterargument has long relied on the belief that bureaucrats in Britain deny treatment to those who most need it, particularly the elderly and disabled.

However, according to the study, researchers at Britain’s National Institute for Health and Clinical Excellence, or NICE, often approved drugs for specific niches of patients with more unusual conditions even if the drug was proved to be less effective than existing drugs or not worth the additional cost.

This approach to medical coverage decisions surprised Darling, who has worked for two decades on comparative effectiveness research.

“People in the [health care] industry love to attack NICE,” Darling said, “but NICE covers most things.”

Employers have strongly supported a health care reform proposal to create a national Center for Comparative Effectiveness. They argue that a centralized center of research would help determine which medical interventions work best and for whom, saving employers money on unnecessary and ineffective medical interventions.

The research could help employers determine which medical treatments and drugs should be covered by health insurance. The goal is to improve care and reduce costs, Darling said. Darling argues that the research could also help device makers, drug companies and other medical providers invest in developing medical technology that is shown to be more effective than alternatives already on the market.

Much of the time, a decision to cover a drug is straightforward, said Braden J. Manns, one of the article’s authors and a professor of medicine at the University of Calgary’s medical school. That’s because comparative effectiveness research shows that one drug is clearly superior to its alternative.

“Seventy percent are no-brainers,” Manns said. “Either the medicine does not work as well or it works better and it doesn’t cost more.”

The article examined how Britain, Canada and Australia used comparative effectiveness research to make coverage decisions, in part to shed light on the health reform debate in the U.S. Researchers focused on the comparative effectiveness of pharmaceuticals, which represent the fastest growing medical expense in Canada, Australia, the U.K. and the U.S.

Of the three countries, Canada approved the lowest percentage of drugs—about half. Australia approved slightly more, 54.3 percent, but authorities there often deem individual drugs too expensive and then use their buying leverage to pressure drug makers to lower their prices.

The U.S., with the largest health expenditures in the world, could use the research to force drug companies to lower their prices, but Darling said that is unlikely to happen.

Instead, the widespread adoption of comparative effectiveness research in the U.S. could lead drug and device makers to use the research while developing their products before seeking Food and Drug Administration approval.

—Jeremy Smerd

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