Modest savings
Whether more comparative research will limit healthcare spending remains to be seen. The Congressional Budget Office estimated
earlier this year that the CER initiative will reduce federal healthcare spending by some $3 billion over 10 years—just about
what the government will spend on PCORI. And that calculation assumes that comparative studies will lead to changes in physician
practice and patient choice. "It's one thing to measure effectiveness; it's a totally different thing for clinicians to have
access to the information and use it," pointed out consultant David Axene at the CER Summit. Under PCORI, AHRQ will continue
to lead efforts to disseminate CER research findings through guides for clinicians and consumers, along with research reviews
and reports.
Potential savings from CER are further limited by Congress' stipulation that Medicare cannot use study results to establish
cost-effectiveness thresholds, set practice guidelines, or make coverage or payment recommendations (i.e., PCORI should not
become another NICE). However, private insurers and payers are free to tap CER evidence in their coverage decisions, as they
have done for years. More outcomes studies will support efforts by payers to negotiate lower rates and steer consumers to
more high-value care options.
Consequently, some analysts believe that CER studies should consider cost and pricing issues. At a briefing last month sponsored
by the journal, Health Affairs
, Harold Sox of Dartmouth Medical School recommends that CER studies include data on utilization and costs so that payers and
the public can kno what they're paying for. And Harvard researcher Steven Pearson made the radical proposal that Medicare
reward innovation by paying higher prices for products that can document superiority, but only a comparable or "reference"
price for those demonstrating comparable clinical effectiveness; new products that fall in the middle would have three years
after FDA approval to collect data supporting a premium price.
At the same time, efforts to limit or curtail treatment choices will remain difficult and require a very high threshold of
evidence. "CER is not a panacea or a silver bullet," stated Kavita Patel, director of health policy at the New American Foundation,
an independent research and poligy organization. Establishing PCORI is "a good first step" toward identifying ways to allocate
resources more wisely, she says, but is wary of using CER primarily as a cost-cutting tool. She and others have advised the
PCORI board to select a few studies that can move forward on a relatively short schedule so that the program will produce
visible results within a year.
Jill Wechsler is Pharmaceutical Technology's Washington editor, 7715 Rocton Ave., Chevy Chase, MD 20815, tel. 301.656.4634, jwechsler@advanstar.com
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