Thursday, September 3, 2009

More on comparative effectiveness

Today I received an email announcing the latest issue of the American Journal of Pharmacy Benefits and found the title of the "From the Editor" piece interesting: Has the Time Come for Comparative Effectiveness Research? This interesting piece makes a very important point: most of the public discussion about comparative effectiveness has focused on making sure that patients receive the most effective treatments. What the editor also points out (and there is a quote from the editorial in large red print on the page) is that "behind closed doors the financial conversations are occurring" (emphasis added).

What does that mean? The term comparative effectiveness has been portrayed to the public as something that is focused specifically on clinical effectiveness, more positive outcomes, and the patient-provider decision making process. Despite this, the main paying stakeholders in the health care system (other than patients who have been told it is largely for better clinical outcomes) are definitely thinking of this as dealing with cost-effectiveness. And, when they start thinking about costs, they are likely to be focused most strongly on their own financial interests. Will patients still benefit in that case? Maybe.

In general, more cost-effectiveness is a good thing. Having a more "rational" health care system is a good thing. The key, and this point is revisited often, is that not everyone shares the same "rationale" for what is "rational". Not everyone shares the same perspective in making decisions on what is most cost-effective. The fact that the paradigm for decision making affects stakeholders who do not all share the same interest must be recognized as a motivator for political compromise if this tool is to be used successfully in the long run.

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