Organizations Recommend Priorities for Comparative-Effectiveness Research

In its report to the President and Congress last week, the Federal Coordinating Council for Comparative Effectiveness Research recommended that data infrastructure be the primary investment for the US Department of Health and Human Services’s (HHS) comparative-effectiveness research (CER) funds. The investment could link data sources, develop distributed electronic data networks and patient registries, and create public–private partnerships.

The report named priority populations (e.g., racial and ethnic minorities, persons with disabilities, persons with multiple chronic conditions, the elderly, and children) as a secondary area of investment. CER could help improve medical decisions for these populations and reduce health disparities.

Medical interventions should be another secondary area of investment, according to the report. Among the interventions mentioned were medical and assistive devices, procedures and surgery, behavioral change, prevention, and delivery systems. Emphasis on behavioral change and prevention could, for example, decrease obesity, decrease smoking rates, and improve patient compliance, according to the report.

In addition, the Institute of Medicine (IOM) submitted its own list of priorities for CER last week. The list comprised 100 recommendations divided into four quartiles. The first quartile included what IOM considered to be the most important priorites including comparing the effectiveness of:

• Various strategies for introducing biologics into the treatment algorithm for inflammatory diseases, including Crohn’s disease, ulcerative colitis, rheumatoid arthritis, and psoriatic arthritis.

• Costs of alternative detection and management strategies for dementia in community-dwelling individuals and their caregivers.

• Various strategies (e.g., clinical interventions, selected social interventions, and combined clinical and social interventions) to prevent obesity, hypertension, diabetes, and heart disease in at-risk populations such as the urban poor and American Indians.

• Genetic and biomarker testing and usual care in preventing and treating breast, colorectal, prostate, lung, and ovarian cancer, and possibly other clinical conditions for which promising biomarkers exist.

• Interventions (e.g., community-based multilevel interventions, simple health education, and usual care) to reduce health disparities in cardiovascular disease, diabetes, cancer, musculoskeletal diseases, and birth outcomes.

In its report, IOM stated that investment in CER should continue after research on its priority list of topics is complete. IOM said that a continuous evaluation of research topic priorities is necessary to increase knowledge, treat emerging diseases, and advance medicine. The Institute called for regular reports of the activities, recommendations, and findings of CER and periodic reevaluation of the nation’s CER portfolio.

The American Recovery and Reinvestment Act (ARRA) provided $1.1 billion for CER, including $400 million to the HHS Secretary. ARRA also established the Federal Coordinating Council for Comparative Effectiveness Research to establish priorities for and coordinate CER. The Council and IOM submitted their recommendations for CER to the President and Congress in compliance with ARRA. HHS Secretary Kathleen Sebelius will consider all the recommendations and develop a plan for the combined $1.1 billion of ARRA CER funding by July 30, 2009.

See related PharmTech articles:

Would Comparative Effectiveness Reduce Patients’ Options? (blog post)

The Comparative-Effectiveness Controversy (PharmTech May 2009 issue)

Comparative Effectiveness May Have Influenced Pfizer Already (blog post)

Federal Comparative-Effectiveness Research Agenda Gets Underway (ePT newsletter)