COMPARATIVE
EFFECTIVENESS RESEARCH
Public Policy Interest and
Issues
Jeanne Lambrew, PhD
Associate Professor
LBJ School of Public Affairs
National Health Policy Conference
February 4, 2008
OVERVIEW
• Public Policy History
• Private Sector Interest
• Recent Legislation
• Issues
• Prospects
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PUBLIC POLICY HISTORY:
United States
• Part of health
services research
– AHRQ as the lead
agency
– Fraction of funding
across agencies
Funding (Millions) for
Agency for Healthcare
Research and Quality (AHRQ)
Dedicated Funding to
Comparative Effectiveness
• Not so new
– Technology
assessment
– Outcomes
research
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Efforts in Other Nations
• Great Britain: National Institute for
Health and Clinical Excellence (NICE)
– Government-based
– Conducts syntheses of comparative
clinical and cost effectiveness
– Existing and new therapies
– Budget: $60 million
• Germany: Institute for Quality and
Efficiency
– Independent, funded through levy
• Australia and others: Condition for
drug, device approval
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PRIVATE SECTOR INTEREST
Payers & Insurers
• Business support
– Business Roundtable
– National Business Group on Health
– Better Health Care Together (Wal-Mart
–SEIU Business-Labor Coalition)
– Key individual firms (e.g., GM)
• Insurer support
– Blue Cross Blue Shield Association
– America’s Health Insurance Plans
– Key individual insurers (e.g., Kaiser)
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Providers & Patients
• Provider support
– Institute of Medicine
– Certain societies (e.g., American
Academy of Family Physicians)
• Consumer support
– AARP
– Consumers Union
– Labor unions
• Coalitions
– Coalition for Health Services Research
– Alliance for Better Health Care
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RECENT LEGISLATION
New Authority in 2003
• Offered as Frist-Clinton amendment in
2003
• Enacted as part of the Medicare
prescription drug law (P.L. 108-173,
Sec. 1013)
– Authorized $50 million for AHRQ
– For syntheses of information to improve
Medicare, Medicaid and SCHIP
– Promotes transparency, dissemination
• Funded at $15 million per year for FY
2005-2007, $30 million for FY 2008
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Allen-Emerson Bill of 2007
• Introduced as “Enhanced Health
Care Value for All Act” (H.R. 2184)
• Major provisions
– AHRQ-based authorization for a center
– New stakeholder advisory commission
– Funding from Medicare and,
eventually, private insurers
• Other provisions
– Coordinating council for health
services research
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CHAMP Act of 2007
• Included in House-passed bill (H.R. 3162)
• Major provisions
– AHRQ-based center
– Authorized to spend $300 million for 2008-10,
$375 million afterwards
– Funded by Medicare and fee of $2 per
privately insured person in 2011 and beyond
• Congressional Budget Office:
– Federal Spending: +$2.4 billion over 10 years
– Federal Savings: -$1.3 billion over 10 years
• Fully offset by 10th year
– System-wide Savings: -$6 billion over 10
years
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ISSUES:
Scope
• Breadth of studies funded
– Clinical comparisons
– Cost comparisons
– New services versus existing ones
• Type of studies funded
–
–
–
–
Randomized control trials
Secondary data analyses
Syntheses
Other
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Funding
• Amount:
– Millions or billions
• Currently $30 million of $339 billion budget
• Some propose $5 billion per year
• Sources: Public versus private
–
–
–
–
Discretionary funding
Mandatory (e.g., Medicare) funding
Private support
Unfunded mandate
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Governance & Placement
• Who makes what decisions
– Priorities
– Methods and transparency
– Use of output
• Placement of funding
– AHRQ – or different / new agency
– Public-private partnership (e.g., FederallyFunded Research and Development
Centers (FFRDCs))
– Quasi-governmental entity (e.g., Institute
of Medicine)
– Non-profit (e.g., CDC Foundation)
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PROSPECTS
Scope
• Medicare legislation in 2008
• Presidential candidates
– Clinton: Best Practices Institute
• Funded by private and public sector
• Compare the effectiveness of alternative
treatments
– Obama: Establish an independent institute
• Guide reviews and research on comparative
effectiveness
– McCain:
• Make public more information on treatment options
• Facilitate the development of national standards for
measuring and recording treatments and outcomes
• Dedicate federal research on the basis of sound
science
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SOURCES OF INFORMATION
• Institute of Medicine. (January 2008). Knowing What
Works in Health Care: Roadmap for the Nation.
Washington, DC: National Academies of Science.
• Congressional Budget Office. (December 2007).
Research on the Comparative Effectiveness of Medical
Treatments. Washington, DC: CBO.
• Wilensky, G.R. (November 7, 2006). “Developing a
Center for Comparative Effectiveness Information,”
Health Affairs Web Exclusive, w-572–w-585.
• AcademyHealth. (September 2005). Placement,
Coordination, and Funding of Health Services Research
within the Federal Government. Washington, DC:
AcademyHealth.
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