Saturday, April 25, 2009

Comparative-Effectiveness: Will we have a US-version of NICE?

The American Recovery and Reinvestment Act (ARRA) of 2009 allocated $1.1 billion for comparative effectiveness research (CER) and associated health services research.  This research will provide new information about the strengths and weaknesses of various health care treatments and strategies, although the research explicity is not to "recommend clinical guidelines for payment, coverage, or treatment."  The compartive effectiveness research will specifically include:  comparison of clinical outcomes, effectiveness, appropriateness of services and procedures to prevent, diagnose, or treat health conditions.  It will also fund data registries, networks, and other ways of creating or compiling health outcomes research data.  

The 15-member Federal Coordinating Council for Comparative Effectiveness Research will coordinate and assist the agencies with the research.  The first public listening session of the Coordinating Council was held 4/14/09 and can be heard here:  http://nmr.rampard.com/fcc/20090414/frame/index.html.  
The Institute of Medicine (IOM) was called to create a consensus report by June 30th, 2009 on recommendations for CER.  We'll see this summer how they frame their recommendations for CER in the future. 

The allocation of funds from ARRA for CER is:  $400 million for the Secretary of Health and Human Services (HHS) (Kathleen Sebelius--confirmed 4/21 by Senate Finance Committee); $400 million for National Institutes of Health (NIH); $300 million for the Agency for Healthcare Research & Quality (AHRQ).  [Aside:  AHRQ is the agency I will be working for this summer, my first summer of my PhD program here in the Baltimore/Washington area.  I will be working in the Center for Financing, Access, and Cost Trends working with the Medical Expenditure Panel Survey (MEPS) on costs to families due to mental disorders.]

CER did receive $1.1b, but for perspective, the other areas of spending on improving US health care are:
1) Improving and preserving health care-- $90.1b
2) Health IT--$20.6b
3) Scientific research & facilities--$10.0b
4) Community health care services--$2.8b
5) Comparative effectiveness--$1.1b
6) Prevention & wellness--$1.0b
7) Accountability and IT security--$.1b

Thinking to the future, an idea is that CER could be housed within one center, which could operate to some degree like the National Institute for Health & Clinical Excellence (NICE) in the British National Health Service (NHS). http://www.nice.org.uk
AHRQ has been suggested as the most likely home for the US version of NICE.  However, there is a debate going on around the formation of something like NICE in the US, primarily because it infers a sense of rationing and includes refusal of care for treatments that are not cost-effective.  Given the unique individualist, anti-government culture of the United States, the degree to which a NICE-like institution could be established in the US is questionable.    Here's hoping the future of CER is embraced by the public and adequately promoted and understood within the realm of health care reform. 
 



1 comment:

Ben Hansen said...

Be sure to read Dr. Grace Jackson's "Open Letter to the Federal Coordinating Council for Comparative Effectiveness Research" posted at the Institute for Nearly Genuine Research web site:
www.bonkersinstitute.org/jacksonletter.html