An Emerging Health Economics Issue
By Staff Reporters
Comparative Medical Effectiveness [CME] is not a new healthcare term or health economics concept. Federal initiatives specifically promoting CME were authorized under the Medicare Modernization Act of 2003, but the genesis took root decades before.
Finally … a Hot Topic
Comparative Medical Effectiveness has recently become a hot topic again throughout the arena of health care stakeholders, due to funding and initiatives advanced by the Obama administration, and the positive and negative reactions drawn by different sectors of stakeholders.
Related to Evidence Based Outcomes
For stakeholders including numerous health care policy organizations, the health plan industry, and various health care provider organizations: public and private promotion of Comparative Medical Effectiveness reviews and processes offer the potential for more evidence-based, outcome-benefit or even cost-benefit driven information to improve the health care decision making for all parties. And, for stakeholders concerned about limiting the role of government and third parties in their level of regulation and control over the direct delivery of specific patient care, Comparative Medical Effectiveness may become a lightening rod due to perceived potential as to how the process and information could ultimately be applied.
Definition of the CBO Report
The Congressional Budget Office Report “Comparative Effectiveness: Issues and Options for an Expanded Federal Role” offers the definition that follows:
“As applied in the health care sector, an analysis of comparative medical effectiveness is simply a rigorous evaluation of the impact of different options that are available for treating a given medical condition for a particular set of patients. Such a study may compare similar treatments, such as competing drugs, or it may analyze very different approaches, such as surgery and drug therapy. The analysis may focus only on the relative medical benefits and risks of each option, or it may also weigh both the costs and the benefits of those options. In some cases, a given treatment may prove to be more effective clinically or more cost-effective for a broad range of patients, but frequently a key issue is determining which specific types of patients would benefit most from it. Related terms include cost–benefit analysis, technology assessment, and evidence-based medicine, although the latter concepts do not ordinarily take costs into account.”
Assessment
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Conclusion
And so, your thoughts and comments on this Medical Executive-Post are appreciated. How do you define this term, and is its’ very definition evolving?
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Quite simply, comparative effectiveness research does exactly what it says: compares the effectiveness of two or more medical treatments for the same medical issue. This enables healthcare decision-making based on evidence instead of opinion, preference, or marketing hype.
For example, if Drug A and Drug B both reduce high blood pressure which works better? The only way to answer this question is to run a well-designed clinical study, with half the patients using Drug A and half using Drug B. Check the results and see which drives the greatest improvements in patient care and outcomes.
Today, this research is largely unavailable except in limited circumstances. Pharmaceutical and medical device manufacturers have zero incentive to test against their competition because the FDA approval process requires testing against a placebo, not competing treatments. Once FDA approval is received, a manufacturer can gear up the marketing machine and capture market share – even if the newly-approved drug or device is not as effective as existing treatments. In many cases, this drives increased cost without commensurate improvements in clinical care or patient outcomes.
At Hayes, we believe U.S. government funding of clinical effectiveness research will go a long way to driving needed change in the healthcare industry. With good, solid comparative effectiveness research, evidence-based medicine can take its rightful place at the forefront of healthcare decision making.
Winifred S. Hayes, RN, MS, PhD
President and CEO
Hayes, Inc.
http://www.hayesinc.com
Dr. Hayes,
Many thanks for your insightful and cogent comments on EBM.
Please feel fee to post or comment again; prn.
Fraternally
Hope Hetico; RN, MHA
[Managing Editor]
Dr. Hayes,
CME is modeled after the National British Health System which promotes rationed medical care. Now, some medical care probably ought to be rationed; like some end-of life-issues; trade-drugs, elective surgery, IVFs, etc.
But, please avoid the euphemisms like CME and EBM, and use the appropriate terms. Rationed care is not necessarily a dirty word; it is already here. So, let’s all get used to it.
Terry
Terry,
For more than 20 years, the Dartmouth Atlas Project has documented variations in how medical resources are distributed and used in the United States. The project uses Medicare data to provide comprehensive information and analysis about national, regional, and local markets, as well as individual hospitals and their affiliated physicians.
These reports, used by policymakers, the media, health care analysts and others, have radically changed our understanding of the efficiency and effectiveness of our health care system. This valuable data forms the foundation for many of the ongoing efforts to improve health and health systems across America; such as EBM and CME. Here is the link for same:
Link: http://www.dartmouthatlas.org/
The site provides access to all Atlas reports and publications, as well as interactive tools to allow visitors to view specific regions and perform their own comparisons and analyses.
Rex
All ME-P Readers,
The issue on CME here is that the two drugs are compared against peers, rather than a placebo.
Dr. David Edward Marcinko, MBA
[Editor-in-Chief]
Dr. Hayes and Dr. Marcinko
Is there any “evidence” that CME actually works to reduce healthcare costs? Please advise.
Thanks.
Deborah RN
FYI: CME Research
The Federal Comparative Effectiveness Research Coordination Council [FCERCC] has posted its draft definition of comparative effectiveness research and the draft criteria for research prioritization at this link – for both review and public comment:
http://www.hhs.gov/recovery/programs/cer/draftdefinition.html
Hope Hetico; RN, MHA
[Managing Editor]
Dear Deborah RN,
I don’t know the answer to your question about CME and cost savings, but here is the link to an excellent article about same. Of course, the Obama Administations thinks it will?
http://correspondents.theatlantic.com/abraham_verghese/2009/05/if_evidence_based_medicine_is_like_sex_based_intercourse_then_comparitive_effectiveness_is_like.php
Cordially,
Samuel
CME is not EBM or ExBM
Expert Based Medicine [ExBM] relies on anecdotal information from leaders in the profession, pathophysiologic mechanisms of disease, case reports and case series.
Evidence Based Medicine [EBM] in contrast emphasizes clinical expertise, patient values, and the reliance on the results of rigorous clinical trials when making decisions about patients.
Sigfried
Hi all; it’s me again.
The Agency for Healthcare Research and Quality just announced that it will provide a series of grants totaling $48 million that can be used to develop national patient registries for comparative effectiveness research. Clinical registries are one of a number of approaches to helping providers identify the long-term effects of treatments, along with clinical data networks and other forms of health IT networking.
http://www.govhealthit.com/newsitem.aspx?nid=71963
Sigfried
Are doctor’s playing hunches?
A just discovered TIME magazine report on EBM.
http://www.time.com/time/magazine/article/0,9171,1590448-1,00.html
Mike
More on C.E.
http://theincidentaleconomist.com/what-is-comparative-effectiveness/
Shane