Magazine article Drug Topics

Comparing the Effectiveness of Drug Treatments

Magazine article Drug Topics

Comparing the Effectiveness of Drug Treatments

Article excerpt

Most Medicare providers and beneficiaries are unaware of the provision for comparative effectiveness research that is part of the Medicare Modernization Act (MMA). Politicians, policymakers, and manufacturers view it as a key initiative for the future of Medicare and beyond.

Insurance plans often lack the data needed to decide which healthcare option represents the best value.

Purchasers presumably would spend resources more efficiently if they had information about how and when the various therapeutic options work best. Comparative effectiveness research evaluates the outcomes of different therapies for the same condition.

Overall costs

Overall costs per Medicare beneficiary vary widely in different sections of the country. This variation is not explained by differences in the respective populations nor does it result in better health outcomes in the higher-spending regions. Moreover, the variation in expenditures is the greatest for conditions for which comparative data are lacking. This suggests that it may be possible to achieve the same, or better, results at lower costs.

Expense is a major reason few comparative clinical trials are done. The recent study comparing coronary stents with drug treatment cost approximately $33.5 million, while the ALLHAT study (comparing different antihypertensive and lipid-lowering drugs) cost more than $83 million. Although several federal agencies conduct some health services research, none focuses on supporting comparative studies. Clinical trials by the private sector focus on establishing efficacy for FDA approval rather than comparing treatment options.

The Agency for Healthcare Research & Quality has received roughly $15 million per year for comparative effectiveness projects pursuant to Section 1013 of MMA. AHRQ set up the Effective Health Care Program that includes Evidence-based Practice Centers to perform systematic reviews of existing research, the Centers for Education & Research on Therapeutics (CERTs) and the DeCIDE network (Developing Evidence to Inform Decisions about Effectiveness) to support new research, and the John M. Eisenberg Clinical Decisions and Communications Science Center to disseminate the knowledge.

Call for legislation

MedPAC (Medicare Payment Advisory Commission), the Blue Cross Blue Shield Association, and the Institute of Medicine have all issued calls for more legislation and resources to compare the effectiveness of new and existing procedures, drugs, devices, and biologies. …

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