WSJ op-ed assails comparative effectiveness research

The January 20 Wall Street Journal included an op-ed from the American Enterprise Institute decrying the potential for a government-funded comparative effectiveness institute.

In this opinion piece, Scott Gottlieb suggests that such a government-funded comparative effectiveness institute
(1) Will not save money
(2) Will use poor scientific methods
(3) Would do research that would be effectively done by the private sector if only the FDA would allow private companies to publicize their comparative effectiveness findings.

My response:
(1) Here are the CBO comments from December, 2007.

Generating additional information about comparative effectiveness and making corresponding changes in incentives would seem likely to reduce health care spending over time—potentially to a significant degree. The precise impact, however, depends on several factors and is difficult to predict. Given the time necessary to conduct the research, to alter incentives in a manner reflecting the results, and to affect behavior through those changes, any potential for substantial cost savings from new research would probably take a decade or more to materialize. Even so, generating additional information comparing treatments would tend to reduce federal health spending somewhat in the near term—but that effect may not be large enough to offset the full costs of conducting the research over that same time period

(2) There is some thought that we might have to settle for research that wouldn’t merit publication in the New England Journal. Question – isn’t some information even if imperfect better than the current state of utter lack of information?

(3) The CBO points out that private parties just don’t have the right incentives to do good comparative effectiveness research. Pharmaceutical and device makers are not likely to be impartial enough (Here’s an example. This article showing that a medicine was ineffective was published in Annals of Internal Medicine 8 years after the completion of data collection. The publication was delayed until long after fluconazole, the drug in question, lost its patent protection). . On the payer side, there is no single health plan (except perhaps Medicare) representing enough of the market to take on this cost.

Comparative effectiveness research is expensive and takes a long time. The UK's National Institute of Clinical Effectiveness faces serious opposition to its efforts to restrict coverage to more cost-effective therapies. (See my previous post on this issue). Doing good comparative effectiveness research could help allocate precious (and not limitless) resources. This research won't happen without government participation, and probably won't have much impact as long as government payers are prohibited from using this information in coverage decisions. I believe we should fund this research through the Agency for Health Research and Quality, and governmental and nongovernmental payers should be able to use this information when designing coverage.

Thanks to Ben Geisler from our class for sending me a link to this article.