Improving Value

Comparative Effectiveness Research

A high-value, patient-centered health care system that is equitable, efficient and produces uniformly high health outcomes requires good evidence. Comparative effectiveness research (CER) helps providers, payers and patients compare the effectiveness of alternative medical treatments to help them determine which courses of treatment are best.

Alarmingly, the majority of clinical decisions are not based on CER.¹ In 2009, the Institute of Medicine estimated that more than half of the treatments delivered do not have clear evidence of effectiveness.² Similarly, Clinical Evidence, a project of the British Medical Journal, found that little was known about the effectiveness of nearly 50 percent of 3,000 medical treatments that had been the subject of randomized controlled trials.

Increased funding for CER would clarify which treatments work best—and for which types of patients—allowing payers to increase spending on effective interventions and lower spending on less effective treatments. It is estimated that nearly 20 percent of current health care spending may be wasted on unneeded services.³

In 2010, Congress authorized the Patient Centered Outcomes Research Institute (PCORI) to fund CER that engages patients and other stakeholders throughout the research process. As of 2018, PCORI had invested nearly $2.4 billion in more than 600 patient-centered CER studies.⁴

One PCORI-funded study on diabetes treatments found no statistically significant differences between type 2 noninsulin-treated diabetics who performed self-monitoring and those who did not.⁵ Over five years, discontinuing self-monitoring in this population would save over $12 billion in health care costs.⁶  

 

Notes

1. Kliff, Sarah, "Surprise! We don't know if half our medical treatments work," Washington Post (January 24, 2013). 

2. "Comparative Effectiveness Research Prioritization," National Academies of Sciences, Engineering and Medicine (June 30, 2009). 

3. Lyu, Heather, et al. "Overtreatment in the United States," PLOS ONE (September 6, 2017). 

4. "Primer: PCORI Background, Funding Streams, and Reauthorization," The PIPC Blog (October 25, 2018). 

5. Young, LA, et al., "Glucose Self-Monitoring in Non-Insulin-Treatment Patients with Type 2 Diabetes in Primary Care Settings: A Randomized Trial," JAMA Internal Medicine, Vol. 177, No. 7 (July 1, 2017). 

6. "Addressing Type 2 Diabetes," Patients-Centered Outcomes Research Institute. 

More on this Topic

• National Academy for State Health Policy: A Roadmap for State Policymakers to Use Comparative Effectiveness and Patient-Centered Outcomes Research to Inform Decision Making (July 30, 2014). 
• Journal of Comparative Effectiveness Research: Improving the Relevance and Consistency of Outcomes in Comparative Effectiveness Research (March 2016).