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New Health Affairs: Promise & Pitfalls Of Comparative Effectiveness Research



October 9th, 2012
by Chris Fleming

The October 2012 issue of Health Affairs provides an in-depth look at challenges in comparative effectiveness research. To surface issues around communication of research results, the issue includes a hypothetical comparative effectiveness case study of a fictional migraine drug and offers varying commentaries and analyses of the hypothetical case study from the Patient-Centered Outcomes Research Institute (PCORI), the Food and Drug Administration, the pharmaceutical industry, payers, and representatives of patient groups.

These and related articles raise questions about how the research might be applied to decision making across the health care system and the ways it could affect how pharmaceutical companies communicate to both health professionals and the public about competing treatments and options in the future.

Other studies examine additional issues related to comparative effectiveness research as well as topics of interest to the pharmaceutical and medical device industries, insurers, health care providers, and consumers.

The new Health Affairs volume will be discussed at a Thursday, October 11, briefing in Washington DC. The issue has funding support from the National Pharmaceutical Council.

Many comparative effectiveness studies fail to change patient care or clinical practice—and there are clear reasons why. Justin Timbie, health policy researcher at RAND Corporation, and colleagues conducted case studies of the dissemination and adoption of findings from key research studies of the past 10 years and identified five underlying factors that blunt the impact of translation of scientific evidence into health care practice: financial incentives, namely fee-for-service payment; ambiguous study results; inherent biases in the interpretation of results; a failure to design the research for the end user; and limited decision support in patient care settings.

The authors recommend policy changes that will promote greater consensus on the objectives and design of these studies; improve the validity of the guideline development process; and address the perverse financial incentives that slow the translation of evidence.

“We’ve made a significant investment in comparative effectiveness research, but historically, we’ve seen very few studies transform clinical care,” said Timbie. “For PCORI and others to succeed in their missions to improve patient care, the policy community is going to have to take deliberate steps to ensure that these translation barriers are addressed at each stage of the evidence translation process.”

Additional articles in the October issue and their lead authors include:
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Other studies of interest include:
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