ARTICLE - Comparative effectiveness and health care spending - implications for reform

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Published at www.nejm.org January 6, 2010 (10.1056/NEJMsb0911104)

Milton C. Weinstein, Ph.D., and A. Skinner, Ph.D.

Comparative Effectiveness and Health Care Spending — Implications for Reform

Title VIII of the American Recovery and Reinvestment Act of 2009

authorizes the expenditure of $1.1 billion to conduct research

comparing " clinical outcomes, effectiveness, and appropriateness of

items, services, and procedures that are used to prevent, diagnose, or

treat diseases, disorders, and other health conditions. " Federal

support of " comparative effectiveness " research has been viewed as a

cornerstone in controlling runaway health care costs.

Although cost is not mentioned explicitly in the comparative

effectiveness legislation, the American College of Physicians and

others have called for cost-effectiveness analysis — assessment of the

added improvement in health outcomes relative to cost — to be on the

agenda for comparative effectiveness research.1,2 This approach has

come under harsh criticism from some who view it as the first step in

health care rationing by the government — that cost cutting will mean

the withdrawal of expensive treatments with small (but still positive)

benefits. Some politicians have therefore tried to restrict any

efforts to use comparative effectiveness to guide U.S. health care

policy.

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Read the full article here:

http://content.nejm.org/cgi/content/full/NEJMsb0911104?query=TOC

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