Defining Comparative Medical Effectiveness

An Emerging Health Economics Issue

By Staff Reportersdhimc-book8

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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24 Responses

  1. 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

    Like

  2. 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]

    Like

  3. 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

    Like

  4. 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

    Like

  5. 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]

    Like

  6. Dr. Hayes and Dr. Marcinko

    Is there any “evidence” that CME actually works to reduce healthcare costs? Please advise.

    Thanks.
    Deborah RN

    Like

  7. 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]

    Like

  8. 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

    Like

  9. 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

    Like

  10. 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

    Like

  11. 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

    Like

  12. Here is an excellent related post on CME by Richard Quinn. He uses the analogy of dining out.

    http://quinnscommentary.com/2009/11/21/dining-out-insurance-no-guidelines/

    Sally

    Like

  13. Evidence-Based Dentistry Conference – Been there

    On December 4, an Arizona Dental Association member posted this on the AzDA Facebook Wall: “ just registered for the ADA EBD conference, but I was wondering if AzDA will cover the travel expenses if I agree to write a series of articles for Inscriptions and/or do a presentation for the foundation.”

    I added the following comment.

    “Dr. T., two years ago about this time I applied for and was awarded a seat at the 1st EBD Conference on May 4, 2008. For me, it was an awakening.

    Even if you must pay your own way to Chicago (like I did), I think it is very important for ADA members to learn about the application of Evidence-Based Dentistry – especially dentists who have NPI numbers and are considering paperless practices.

    I also described my impressions of the 2008 EBD Conference on Pruitt’s Platform – my blog.

    ‘Evidence-Based Dentistry – My search for truth’”

    http://community.pennwelldentalgroup.com/forum/topics/evidencebased-dentistry-my

    ——————————-

    If the AzDA supervisor who oversees the Facebook follows the link to my critical (and popular) search for truth article, he or she probably won’t like the truth I found in Chicago Headquarters a year and a half ago. And if the supervisor is as image conscious as the TDA Facebook supervisor was when she had a TDA Facebook to supervise, there might be some anxiety happening.

    D. Kellus Pruitt; DDS

    Like

  14. Lansdale, PA – May 13, 2010

    A guide to BRCA1 and BRCA2 genetic testing has been released by Hayes, Inc. This comprehensive resource is designed to equip physicians and other healthcare professionals who are not trained in genetics with independent, evidence-based information to help them understand the complexities of BRCA1/2 gene testing.

    Ann Miller RN, MHA
    [Executive-Director]

    Like

  15. On Evidence Based Medicine

    The policy journal Health Affairs published a new study from the California HealthCare Foundation.

    http://content.healthaffairs.org/cgi/content/full/hlthaff.2009.0296v1

    The report, “Evidence That Consumers Are Skeptical about Evidence-Based Health Care” found that consumers generally believe that new medical care, and more health care, is almost always better.

    http://www.kaiserhealthnews.org/Stories/2010/June/03/npr-patient-survey-more-health-care.aspx

    Dr. CE. Koop was right when he opined that patient education is the surest route to better health and less costly healthcare. Too bad we seem to pursue every avenue but, in this country.

    Shane

    Like

  16. IOM Offers Standards for Clinical Practice, Comparative Effectiveness

    The Institute of Medicine has issued eight recommended standards to develop trustworthy clinical practice guidelines and 21 recommended standards for systematic review of the comparative effectiveness of medical or surgical interventions. The IOM also said it encourages HHS’ Agency for Healthcare Research and Quality to pilot-test the standards and assess their reliability and validity.

    “If guideline users had a mechanism to immediately identify high quality, trustworthy clinical practice guidelines, their health-related decision-making would be improved—potentially improving both healthcare quality and health outcomes,” the IOM wrote in a description of its report “Clinical Practice Guidelines We Can Trust,” which outlines eight standards that address issues including transparency, conflict of interest, and external reviews.

    Source: Jessica Zigmond, Modern Healthcare [3/23/11]

    Like

  17. Empirical guesses versus data-mining

    Early in my practice, when I came across a tooth that was difficult to numb I was perhaps too quick to assume that my injection technique was to blame rather than subclinical pulpitis. Over many years, I’ve recognized that more often than not, hypersensitive teeth later need root canals. But that’s still little more than a guess.

    Want answers, Doc? Empiricism takes decades and can be terribly misleading. On the other hand, data-mining de-identified dental records on an internet platform could be done in real time, and would pose no threat to either dentists or patients.

    Think about it.

    Darrell K. Pruitt DDS

    Like

  18. Dr. Hayes,

    Physicians should do more to tailor care based on cost-effectiveness research of large population groups to individual patients, at least according to a study by Stanford University School of Medicine.

    Incremental cost-effectiveness research (ICER) is a concept for choosing among diverse interventions competing for limited resources.

    http://www.medscape.com/viewarticle/746218

    Hope R. Hetico RN MHA

    Like

  19. How comparative effectiveness fails

    A 1993 JAMA paper by John Furguson, Michael Dubinsky, and Peter Kirsch http://jama.ama-assn.org/content/269/16/2116.short is a nice complement to the recent post of Auastin Frakt PhD on the challenges that private insurers would (and do) have in making coverage decisions based on comparative effectiveness research (CER).

    http://theincidentaleconomist.com/wordpress/how-comparative-effectiveness-fails-ctd/

    Ann Miller RN MHA

    Like

  20. Can Comparative Effectiveness Research Help Reduce Health Care Costs?

    Ann and Hope – Here is an interesting article by Amitabh Chandra, Anupam Jena and Jonathan Skinner.

    http://www.nber.org/bah/2011no3/w16990.html

    Franklin

    Like

  21. CE

    According to a recent study published in the October issue of Health Affairs, comparative effectiveness studies of widely used treatments can change practice patterns, thereby reducing healthcare costs.

    http://www.healthcarefinancenews.com/news/comparative-studies-widely-used-treatments-could-lead-cost-savings?topic=05,19

    Ann Miller RN MHA

    Like

  22. An Insider’s Look at CER

    http://nashhealthpolicy.blogspot.com/2013/04/an-insiders-look-at-comparative.html

    From our colleague David B. Nash MD MBA over at Jefferson Digital Commons.

    Ann Miller RN MHA

    Like

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