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The Politics of Comparative Effectiveness Research: Lessons from Recent History

Published on Feb 1, 2014in Journal of Health Politics Policy and Law1.839
· DOI :10.1215/03616878-2395199
Corinna Sorenson14
Estimated H-index: 14
(LSE: London School of Economics and Political Science),
Michael K. Gusmano18
Estimated H-index: 18
(Hastings Center),
Adam Oliver19
Estimated H-index: 19
(LSE: London School of Economics and Political Science)
Abstract
Efforts to support and use comparative effectiveness research (CER), some more successful than others, have been promulgated at various times over the last forty years. Following a resurgence of interest in CER, recent health care reforms provided substantial support to strengthen its role in US health care. While CER has generally captured bipartisan support, detractors have raised concerns that it will be used to ration services and heighten government control over health care. Such concerns almost derailed the initiative during passage of the health care reform legislation and are still present today. Given recent investments in CER and the debates surrounding its development, the time is ripe to reflect on past efforts to introduce CER in the United States. This article examines previous initiatives, highlighting their prescribed role in US health care, the reasons for their success or failure, and the political lessons learned. Current CER initiatives have corrected for many of the pitfalls experienced by previous efforts. However, past experiences point to a number of issues that must still be addressed to ensure the long-term success and sustainability of CER, including adopting realistic aims about its impact, demonstrating the impact of Patient-Centered Outcomes Research Institute (PCORI) and communicating the benefits of CER, and maintaining strong political and stakeholder support.
  • References (41)
  • Citations (11)
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The Patient-Centered Outcomes Research Institute . . . shall not develop or employ a dollars per quality adjusted life year (or similar measure that discounts the value of a life because of an individual's disability) as a threshold to establish what type of health care is cost effective or recommended. The Secretary shall not utilize such an adjusted life year (or such a similar measure) as a threshold to determine coverage, reimbursement, or incentive programs under title XVIII. — The Patient ...
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#1John K. Iglehart (Patient-Centered Outcomes Research Institute)H-Index: 1
The creation of a public-private institute to direct new comparative effectiveness research represents a challenging new chapter in America’s on-again, off-again support for determining what works in health care.
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#1Kavita Patel (New America Foundation)H-Index: 13
The Patient Protection and Affordable Care Act established a new public-private entity for comparative effectiveness research: the Patient-Centered Outcomes Research Institute. The institute is charged with identifying priorities, establishing an agenda, and carrying out comparative effectiveness research. The political process through which the institute was formalized greatly influenced its scope and charge, including the organization’s goals, its unique private-public composition, and its fun...
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We conducted two national surveys of public opinion about comparative effectiveness research and the integration of findings from the research into clinical practice. The first survey found broad support for using research results to provide information, but less support for using them to allocate government resources or mandate treatment decisions. In addition, the public is willing to consider the use of financial incentives to encourage patients to choose cheaper treatments, if research demon...
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