Kalipso Chalkidou, M.D., Ph.D., Sean Tunis, M.D., M.Sc., Ruth Lopert, M.D., Lise Rochaix, Ph.D., Peter Sawicki, M.D., Ph.D., Mona Nasser, Ph.D., and Bertrand Xerri, M.D.
K. Chalkidou, S. Tunis, R. Lopert et al., "Comparative Effectiveness Research and Evidence-Based Health Policy: Experience from Four Countries," Milbank Quarterly, June 2009 87(2):339–67.
An abstract is available at: http://www.milbank.org/quarterly.html
This study examines the key features of government agencies created in Australia, France, Germany, and the United Kingdom to lead research into the comparative effectiveness of medical treatments, procedures, and technologies. In each of the four countries studied, the agencies have a clear mandate to produce information that will inform clinical and health policy decisions. By contrast, comparative effectiveness legislation under consideration in the U.S. Senate explicitly separates the generation of knowledge from health care decision-making.
A part of the recent discussions about U.S. health system reform has focused on the need for better evidence on the comparative effectiveness of various clinical treatments. Other countries’ experiences in creating and operating comparative effectiveness research agencies may provide useful lessons to inform these discussions.
The authors suggest that U.S. policymakers considering a comparative effectiveness research agency should: 1) develop principles governing such an agency’s independence, transparency, and inclusiveness, among other factors; 2) be willing to learn and evolve; 3) clarify for stakeholders that the objective is to improve the quality of care and ensure value; and 4) create broad-based governing structures. To ensure success, the agency will require strong political endorsement, especially in the early days. In addition, its leaders will need to anticipate controversy and engage with stakeholders to address it, and promote buy-in among clinicians by demonstrating a commitment to high-quality, evidence-based care.
The authors drew on their experience as senior technical and administrative staff involved in creating and running comparative effectiveness research agencies in the four countries included in this study. In addition, they compiled information from the agencies’ Web sites, legal documents, literature review, and interviews with stakeholders. The analysis was informed by an international workshop on comparative effectiveness research that was sponsored by The Commonwealth Fund and attended by U.S. and international experts.
While Australia, France, Germany, and the U.K. have developed comparative effectiveness research agencies to suit their unique circumstances, the four agencies share common features that should be carefully considered by U.S. policymakers.