The $787 billion economic stimulus bill approved by Congress includes funding that will allow the federal government to obtain information on the comparative effectiveness of different treatments for specific illnesses. The bill allocates $1.1 billion to the Health and Human Services Department (HHS) to conduct research comparing drug treatments, medical devices, surgery, and other interventions used in the treatment of specific diseases. The allocation can be used for both systematic reviews of published studies and head-to-head clinical trials. Coordination of the research will rest with a council of federal employees, who will also make recommendations to President Obama on how the $1.1 billion should be allocated.
Groups supporting the research initiative say it will provide much-needed evidence for the value-and maybe also the cost-of 1 treatment over another. These supporters include consumers, labor unions, employers, and pharmacy benefit managers.
Pharmaceutical companies and device makers, however, worry that insurers could use the research results to deny coverage, particularly for expensive treatments. The government could use the research findings in developing clinical guidelines that, if enforced, could intrude upon the doctor-patient relationship.
The idea that bureaucrats will be responsible for deciding whether physicians are following government regulations for medical care does not sit well with many people. Several commentators raised the concern that care could be rationed, particularly for vulnerable populations, such as the elderly or disabled.
A report by the House Appropriations Committee cited the end of prescriptions for less effective, more expensive treatments as 1 of the potential payoffs from the research. House and Senate negotiators subsequently stated in a report accompanying the bill that mandating reimbursement policies was not the intention of the research.
One drawback to comparative effectiveness studies is that they may yield broad population averages that are not applicable to specific populations of patients, such as women or minorities, who are often underrepresented in clinical trials. The final bill ensures that such groups will be included in the research.
How the research findings will be used remains an open question. Undoubtedly, private insurers will be interested in the results, but the implication for Medicare policies is unknown. European countries, including the United Kingdom and France, have long supported official organizations that compare the clinical effectiveness of treatments, including cost factors. The ultimate usefulness of such data in improving health care is still debated.
