CER Around the World

Both the stimulus bill (i.e., The American Recovery and Reinvestment Act of 2009 [ARRA]) and Obamacare (the Affordable Care Act [ACA]) contain provisions to increase funding for compariative effectiveness research (CER).  According to a Deloitte Issue Brief, ARRA provided the foundation for the ACA’s newly mandated and immediately effective CER entity, the Patient-Centered Outcomes Research Institute…

Use Of Comparative Effectiveness Research By Four European Health Authorities

How do different European health authorities use comparative effectiveness research (CER) to determine drug coverage and pricing?  A recent Health Affairs article by Cohen, Malins and Shahpurwala answer just this question.  Here is a table summarizing the mission and priorities of health authorities in England, France, Germany and the Netherlands.   Source: Joshua Cohen, Ashley…

Setting FDA Standards

To what standard should the FDA hold new drugs?  The FDA has a number of choices.  Drugs companies could be required to prove that the drugs they make: Do no harm. Are more effective than placebos Are more effective than existing drugs Are more cost-effective than existing drugs, or Are both more effective and more…

Why does cost effective care spread so slowly

According to Fuchs and Millstein, here’s why: Insurers hesitation to standardize coverage.  Standardization of coverage would force insurance companies to compete primarily on the basis of price, which would put pressure on their profits. Employers bear too much of the marginal cost from employees choosing expensive health plans.  Because companies wish to avoid alienating employees,…

Who’s running the Patient-Centered Outcomes Research Institute (PCORI)?

As part of Health Reform, the government created the a center to study clinical effectiveness of different health treatments.  This center, known as the Patient-Centered Outcomes Research Institute (PCORI), “does not have the power to mandate or even endorse coverage rules or reimbursement for any particular treatment.”  What leverage does the Institute have?  Not too…

Patient Heterogeneity and Comparative Effectiveness Research

According to Kathleen Lohr, the most pressing issues for comparative effectiveness research (CER) include: 1) how to conduct CER for heterogeneous patient populations and 2) ways to implement longitudinal investigations to capture long-term health outcomes.  Today I will focus on measuring patient heterogeneity.  Although it makes sense to take into account differences across patients, measuring…