U.S. Panel Lists Priorities for Comparative Effectiveness Research

On Tuesday, an Institute of Medicine panel issued a report listing 100 health topics that should receive high priority as the Obama administration spends $1.1 billion on comparative effectiveness research, the New York Times reports (Meier, New York Times, 7/1).

The recommendations specifically apply to comparative effectiveness research conducted by HHS. Such research received $400 million in funding from the federal stimulus package.

The report likely will "help set a broad agenda for comparative studies" of medical treatments beyond those conducted by HHS, the Wall Street Journal reports.

The 100 topics were chosen from about 2,600 suggestions gathered from professional groups, policymakers and the public. Seventeen suggestions came from medical device companies and 11 came from drugmakers and biotechnology firms (Yao, Wall Street Journal, 7/1).

The IOM panel considered areas of research based on:

• How many U.S. residents are affected by a certain condition;
• Whether effectiveness evidence is lacking for different treatments of a certain condition; and
• Whether comparative-effectiveness research could alter medical practice (Rubin, USA Today, 7/1).

Recommendations

The panel recommended 29 categories that should be prioritized, including both primary and secondary care research areas.

The top category was health delivery, followed by:

• Disparities;
• Disabilities;
• Cardiovascular;
• Geriatrics;
• Psychiatry;
• Neurology;
• Pediatrics;
• Endocrinology; and
• Musculoskeletal (Simmons, HealthLeaders Media, 6/30).

The top 25 specific areas of research the committee named include treatments for abnormal heart rhythm, methods for preventing falls by elderly people, methods of reducing hospital-acquired infections, treatments for Alzheimer's disease and dementia, and the use of imaging equipment to detect and diagnose cancer.

The top 25 priorities also included nonclinical areas of research, such as obesity-prevention efforts in schools and how best to make comparative effectiveness results accessible for physicians and patients (Wayne, CQ Today, 6/30).

The panel also recommended spending a large portion of comparative effectiveness research funding on computer systems that would allow researchers to mine medical records for data on health outcomes (New York Times, 7/1).

Comments

Harold Sox, editor of the Annals of Internal Medicine and co-chair of the committee, called the report "an initial list only," adding that "priority-setting needs to be a continuous process." He also noted the importance of ensuring that doctors and patients are aware of new findings.

"Our country hasn't done as well as it could in translating good research into practice," Sox said (USA Today, 7/1).

Some critics have expressed concerns that comparative effectiveness research could be used to limit treatments available to patients and have a negative impact on those who might benefit from a treatment not found to be the most effective in a majority of patients.

However, the panel said that the research should not be about identifying treatments that will not be covered by insurers or the federal government but instead should seek to provide the best information on how to treat individual patients (Neergaard, AP/Houston Chronicle, 6/30).

The report also noted that researchers did not consider cost-effectiveness in their decisions (CQ Today, 6/30).

Panel Co-Chair Sheldon Greenfield, who is also the executive director of the UC-Irvine Health Policy Research Institute, said, "This report lays the foundation for an ongoing enterprise to provide the evidence that health care providers need to make better decisions and achieve better results."