Federal research initiative aims to compare effective treatments

June 1, 2010

Comparative effectiveness research is suddenly flush with fundings. Tucked in last year's American Recovery and Reinvestment Act was $1.1 billion to accelerate CER.

Key Points

Comparative-effectiveness research (CER), which compares benefits and harms of different prevention, diagnosis and treatment methods head-to-head, is suddenly flush with funding.

Tucked into last year's American Recovery and Reinvestment Act was $1.1 billion to accelerate CER. This year the president's proposed budget requests $286 million for CER, and the Patient Protection and Affordable Care Act (PPACA) includes $10 million this year, $50 million next year, and $150 million in 2012. But it's how all that money will be spent that matters.

"The healthcare bill could be a significant contribution to comparative-effectiveness research," says Vivian Ho, the James A. Baker III Institute Chair in Health Economics at Rice University and associate professor at Baylor College of Medicine.

A committee and a council were formed to help the Department of Health and Human Services (HHS), NIH and the Agency for Healthcare Research and Quality (AHRQ) allocate the $1.1 billion from the 2009 reinvestment act.

The committee was convened by the Institute of Medicine (IOM), which developed a list of 100 priority health topics, based on input from health professionals, consumer advocates, policy analysts, and others who submitted 1,268 initial nominations through a public online form. The list (which is found at http://www.iom.edu/) reflects a range of clinical categories, populations, interventions, and research methodologies.

For example, suggestions called for discrete study of best practice treatments for racial minorities with certain chronic diseases.

The new 15-member Federal Coordinating Council for Comparative Effectiveness Research indicated most of the $400 million total awarded to HHS should be spent on improving the current data infrastructure to better share information. It also recommended CER funds be focused on specific populations, such as racial and ethnic minorities, people with disabilities and multiple chronic conditions, the elderly and children.

"The struggle is what to do first," says Andrew Nelson, HealthPartners vice president and executive director of the HealthPartners Research Foundation, a not-for-profit corporation within HealthPartners that often applies for federal research funds. "The top 100 gives funding agencies a map to start with."

But Ho isn't so sure the top 100 is the right map to use and is unclear on why certain recommendations were in the upper quartile. She doesn't feel they would all have the highest impact on patient care or controlling costs.

Of the federal funds for CER, $300 million went to AHRQ, which has previous experience with such studies. It has been conducting CER since 2003 under the Effective Health Care Program, which coordinates researchers to compare treatments and other healthcare servicees to determine efficacy.

"We focus on horizon scanning, evidence gap identification, evidence synthesis, evidence generation, dissemination and translation, and research training and career development," says Lia Hotchkiss, a manager of AHRQ's CER portfolio.

Topics for AHRQ research are determined through suggestions from stakeholders and the general public. They generally fall into one of 14 priority condition areas, such as cancer, mental health disorders or obesity.

The majority of American Recovery and Reinvestment Act CER funding has been awarded or obligated, but the CER funding from PPACA is just getting started. Part of the new healthcare bill creates the Patient-Centered Outcomes Research Institute, an independent, not-for-profit body that will establish a national CER agenda. It will be governed by an appointed board that includes directors of NIH and AHRQ, private payers, drug and device industries, quality improvement organizations, and other health agencies.

"The board will have a great deal of influence in what they choose to research," Ho says. "They're still trying to read the legislation and understand it. It's a huge endeavor that will take awhile to get going. I expect it will ramp up in three or four years."

Nelson agrees. He says the stimulus funds and the new research institute are just the beginning for CER.