CHDS Academic Director, Professor C. Weinstein, Participates in Panel Discussion on Comparative Effectiveness

In an interview for Medscape One-on-One, conducted by Eli Adashi, Professor of Medical Science and former Dean of Medicine and Biological Sciences at Brown University, Dr. Milton C. Weinstein, Henry J. Kaiser Professor at HSPH and Dr. JoAnn E. Manson, Professor of Medicine at HMS and Chief of Preventive Medicine at the Brigham and Women's Hospital discussed the topic of comparative effectiveness. Professor Adashi posed the question, “What is comparative effectiveness? Where does it intersect with cost-effectiveness? And how, if and when might it affect the US healthcare scene and its variant constituencies?”

Professor Weinstein described comparative effectiveness as comparing “the benefits and the risks of alternative clinical approaches to a health problem”. He pointed out that in the United States, “comparative effectiveness research has been going on for at least half a century, but under different names…..such as outcomes research”. Professor Manson added that with the vast amount of new information (e.g., more tests, procedures, treatments) it has become increasingly difficult for clinicians and patients to access and incorporate new knowledge, and the latest evidence, into clinical practice. She pointed out that “a major goal of the comparative effectiveness research program is to involve consumers and policy-makers and payers in some of these decisions, so that it's really a collaborative process”. Manson served as a member of the Institute of Medicine Committee on Comparative Effectiveness Research Prioritization, whose report was released in mid-2009. The charge of the Institute of Medicine Committee on Comparative Effectiveness Research was to make recommendations to the government about the use of $400 million of a $1.1 billion budget.

When asked about the relationship of cost-effectiveness to comparative effectiveness, Professor Weinstein described cost-effectiveness as a type of comparative effectiveness research that goes a step further to include comparisons of the incremental costs in addition to incremental benefits of alternative interventions. He provided an overview of the history of cost-effectiveness in the United States beginning with the early analyses conducted by the Office of Technology Assessment (at that time an agency of the U.S. Congress) in the 1970s and 1980s, to inform guidelines for Medicare coverage of new medical procedures. He described the short life of the National Center for Health Care Technology in the 1980’s which was originally created to evaluate the cost-effectiveness of health technologies, and then pointed out the fairly consistent role of the Centers for Disease Control and Prevention in conducting cost-effectiveness analyses of preventive services.  The convening of the Panel on Cost-effectiveness in Health and Medicine, of which Professor Weinstein was a chairman, by the Secretary of Health and Human Services, was another sign of government interest in cost-effectiveness analyses (for more information see the panel's three articles 1, 2 & 3), however, despite this intermittent interest the true influence on policy has not been explicit. He pointed out that “Guideline panels of the medical professional societies do cite cost-effectiveness studies from time to time in making their recommendations, but there's been very little explicit use of cost-effectiveness analysis in the formulation of government policy.” He then compared this position to that of Australia, Canada, the United Kingdom and other parts of Europe where cost-effectiveness analysis is used explicitly in policy setting for health care, procedures and drugs. Both he and Dr Manson briefly discussed the challenges they see in the U.S. to the rising interest in comparative effectiveness. Click here to view the live interview. For more information see Professor Weinstein's podcast in which he discussed comparative effectiveness research in health care. Also see the Annals of Internal Medicine article ‘Information on Cost-Effectiveness: An Essential Product of a National Comparative Effectiveness Program,which addresses the need for cost-effectiveness information in the U.S. It examines the current reluctance to use cost-effectiveness analysis and argues for the importance of this information for all health care stakeholders

Information above adapted from Medscape One-on-One: Comparative Effectiveness. [Eli Y. Adashi, MD; JoAnn E. Manson, MD, DrPH; Milton C. Weinstein, PhD]. Available at: http://www.medscape.com/viewarticle/720065