Sidebar: And $1.1 billion goes to...

“Comparative effectiveness” is another “hot” trend in health care policy circles.  The economic stimulus bill passed by Congress and signed into law by President Obama in February included about $1.1 billion in funding for “comparative effectiveness” research.  Part of that money will be used to set up a “Federal Coordinating Council for Comparative Effectiveness Research.”

In theory, the government would fund comparative effectiveness research for the purpose of determining which treatments work best.  This would both improve health care quality and save money by reducing the use of less effective treatments.

But what will the government do when research doesn’t yield a clearly superior treatment?  In February 2008, the U.S. Agency for Healthcare Research and Quality examined the research on prostate cancer and found “that scientific evidence has not established surgery or any other single treatment as superior for all men.”

And what, exactly, is comparative effectiveness?  The head of economic policy at the Biotechnology Industry Organization examined this question not long ago and concluded that there “is no standard definition for comparative effectiveness.” Of the definitions used by leading organizations, all had in common that comparative effectiveness meant research that determines if one treatment produces better health outcomes than another.  Yet there was no consensus on whether the definition included “cost.”  A Congressional Budget Office report captured the confusion stating that comparative effectiveness research “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 the parts of the stimulus bill that allocate funding for comparative effectiveness research, the term “cost” does not appear, an indication that Congress has not taken the issue very seriously.  Comparative effectiveness research may be able to determine if one treatment is more effective, but whether a better treatment is worth the extra cost will ultimately have to be a political decision.

Such decisions can be matters of life and death.  Briton Jack Rosser needs the drug Sutent to treat his kidney cancer.  Research shows that, on average, Sutent can extend the lives of people like Rosser by about two years.  But the British National Health Service recently decided that the added benefit was not worth the $4,650 cost per treatment.

Is Congress giving long and serious thought to the issues involved in comparative effectiveness research?  Not likely.  Rather, it is following the comparatively ineffective strategy of spending money now and kicking the tough choices down the road.