An effort enabled by the new economic stimulus package could lead to informing the medical community on which therapies are the most effective in treating a variety of major health issues.
Congress has allotted $1.1 billion in order to begin the process of determining the most cost-effective treatments for health problems such as hearing loss, back pain, prostate cancer and irregular heartbeat.
Regulators hope that by finding which treatments work best, doctors and patients will save time and money from the current plan that involves a series of hit-or-miss treatments.
As a part of the American Recovery and Reinvestment Act (ARRA), Congress directed the Institute of Medicine (IOM) “to recommend national priorities for research questions to be supported by CER (comparative effectiveness research) and ARRA funds.”
Issued on June 30, the IOM’s “Initial National Priorities for Comparative Effectiveness Research” report lays out a list of the top 100 medical issues to be addressed by Congress using the stimulus funds.
“Clinical research provides health care providers with information on the natural history of disease, clinical presentations of disease, and diagnostic and treatment options,” according to the report.
“All too often, the information necessary to inform these medical decisions is incomplete or unavailable, resulting in more than half of the treatments delivered today without clear evidence of effectiveness.
“This uncertainty contributes to great variability in managing clinical problems, with costs and outcomes differing markedly across the country.”
The report provides a definition for CER as “the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care.
The report issues a “list of priorities” to be focused on using the national investment for CER, including:
– Compare the effectiveness of treatment strategies for atrial fibrillation including surgery, catheter ablation, and pharmacologic treatment.
– Compare the effectiveness of the different treatments (e.g., assistive listening devices, cochlear implants, electric-acoustic devices, habilitation and rehabilitation methods [auditory/oral, sign language, and total communication]) for hearing loss in children and adults, especially individuals with diverse cultural, language, medical, and developmental backgrounds.
– Compare the effectiveness of primary prevention methods, such as exercise and balance training, versus clinical treatments in preventing falls in older adults at varying degrees of risk.
– Compare the effectiveness of dissemination and translation techniques to facilitate the use of CER by patients, clinicians, payers, and others.
– Compare the effectiveness of different strategies of introducing biologics into the treatment algorithm for inflammatory diseases, including Crohn’s disease, ulcerative colitis, rheumatoid arthritis, and psoriatic arthritis.
– Compare the effectiveness of various screening, prophylaxis, and treatment interventions in eradicating methicillin resistant Staphylococcus aureus (MRSA) in communities, institutions, and hospitals.
“Health care decisions too often area matter of guesswork because we lack good evidence to inform them,” committee co-chair Harold Sox, editor, Annals of Internal Medicine, American College of Physicians of Internal Medicine, Philadelphia, said in a statement.
“For example, we spend a great deal on diagnostic tests for coronary heart disease in this country, but we lack sufficient evidence to determine which test is best.”
The committee narrowed down a list of 1,268 suggested items to create the list of the top 100 issues which need to be addressed.
“This report lays the foundation for an ongoing enterprise to provide the evidence that health care providers need to make better decisions and achieve better results,” said co-chair Sheldon Greenfield, Donald Bren Professor of Medicine and executive director, Health Policy Research Institute, University of California, Irvine.
“To make the most of this enterprise, HHS will need to ensure that the results are translated into practice and that the public is involved in priority setting to ensure that the research is relevant to everyday health care.”
—
On the Net:
Comments