Comparative Effectiveness Research (CER)
Comparative effectiveness research (CER) compares two or more treatments on the basis of effectiveness, benefit and risk. Treatments include more than medications. Treatments compared may be devices, tests, procedures, or other intervention designed to improve health.
The ACA provides funding for CER through the Patient Centered Outcomes Research Institute (PCORI). PCORI studies can be original research or the analysis of existing data. The ACA contains language restricting the use of data regarding cost, specifically use of QALYs. PCORI research cannot use cost per QALY to make decisions on coverage for Federal programs. Why? Because of the concern that the quality adjustment used to determine a QALY discounts the lives of the old and ill. Thus, CER (comparative effectiveness research) has not been universally embraced (think death panels). As you can tell, the issues are complicated and it remains unclear how this will be fully resolved.
FAQ: Comparative Effectiveness Research
Why is comparative effectiveness research needed? What problem is it trying to solve?
- If you don't get the best possible information about your treatment choices, you might not make an informed decision on what treatment is best for you.
- When you shop for a new car, phone or camera, you have lots of information about your choices. But when it comes to choosing the right medicine or the best health-care treatment, clear and dependable information can be very hard to find.
- It's true that some treatments may not work for everyone, and that some treatments may work better for some people than others. This research can help identify the treatments that may work best for you.
What are the practical benefits of comparative effectiveness research?
- You deserve the best and most objective information about treating your sickness or condition. With this research in hand, you and your doctor can work together to make the best possible treatment choices.
- For example, someone with high blood pressure might have more than a dozen medicines to choose from. Someone with heart disease might need to choose between having heart surgery or taking medicine to open a clogged artery. Reports on these topics and others include the pros and cons of all the options so that you and your doctor can make the best possible treatment decision for you or someone in your family.
- Every patient is different — different circumstances, different medical history, different values. These reports don't tell you and your doctor which treatment to choose. Instead, they offer an important tool to help you and your doctor understand the facts about different treatments.
Patient A has a common and life threatening condition. The current treatment provides a life expectancy of 2 years at a quality level of 0.3.A radical new treatment recently approved by the FDA gives a life expectancy of 2 years and 3 months at a quality level of 0.4. Costs of the current treatment is $5000 per year, while the costs of the new treatment is $25000 per year.
1) Compute the current and new QALYs. What is the difference in QALY between the current and new treatments?
2) What is the incremental cost of the new drug for an added QALY?
3) Should payers pay for the new drug? (Use a standard of $100,000 per QALY as the upper limit for payment.)
4) Suppose that 250,000 people have the condition described above. Given the information provided above for this scenario, what is the cost of the current treatment to the total health care system?
5) Suppose again that 250,000 people have the condition described above. What will be the cost of the new treatment to the total health care system?