About this time last year (2008), most people probably had not heard the term comparative effectiveness, but a lot has happened since then. In the summer of 2008, bills promoting comparative effectiveness were introduced in both the U.S. Senate and House. Even though these bills never came to a floor vote, the publicity surrounding the bills expanded the discussion. With the election of a new president and large Democratic majorities in both houses last November, the movement for national reform of the healthcare delivery system gained momentum. As part of the stimulus package passed by Congress this winter, $1.1 billion of new federal spending was committed to comparative effectiveness research. A new Federal Coordinating Council for Comparative Effectiveness Research also was created. People began to realize that comparative effectiveness is something to pay attention to.
Comparative effectiveness is a process for evaluating medical evidence as it applies to the comparison of treatments or other medical interventions. The above-mentioned Federal Coordinating Council just published the "official definition" which is:
"Comparative effectiveness research is the conduct and synthesis of systematic research comparing different interventions and strategies to prevent, diagnose, treat and monitor health conditions. The purpose of this research is to inform patients, providers, and decision-makers, responding to their expressed needs, about which interventions are most effective for which patients under specific circumstances. To provide this information, comparative effectiveness research must assess a comprehensive array of health-related outcomes for diverse patient populations. Defined interventions compared may include medications, procedures, medical and assistive devices and technologies, behavioral change strategies, and delivery system interventions. This research necessitates the development, expansion, and use of a variety of data sources and methods to assess comparative effectiveness. "
This definition is broad and complicated, but it has some important features. First, it emphasizes that the purpose of comparative effectiveness research is to help people make decisions. Second, it draws attention to the fact that not all people with a particular disease are the same. A particular intervention may be best for certain people, while a different intervention may be best for others. One way the definition could be improved is to expand on what is meant by outcomes. Most medical treatments provide benefits by reducing the severity of (and sometimes curing) a particular disease. However, treatments sometimes also can harm people. For example, most people are aware that antibiotics made from penicillins can cause severe (even fatal) allergic reactions. These harms, while often rare, are also important outcomes. In evaluating the effectiveness of medical treatments and interventions, both benefits and harms must be considered.
Where can people get more information about comparative effectiveness? One of the best places to start is a Web site by the federal Agency for Healthcare Research and Quality. The site's address is:
www.effectivehealthcare.ahrq.gov
It has a variety of reports that summarize comparative effectiveness for different diseases. It also has summaries of the scientific issues that underlie how to conduct comparative effectiveness research.
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