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How CER Could Pay for Itself—Insights from Vertebral Fracture Treatments

The Issue

Comparative-effectiveness research (CER) can help determine whether the risks associated with a particular medical procedure outweigh its benefits. Findings from CER may be used to limit the use of ineffective treatments and ultimately help to free up resources for safer and more effective forms of care.

What the Study Found

In a New England Journal of Medicine Perspective, Adam Elshaug, a Commonwealth Fund Harkness Fellow in Health Care Policy, and coauthor Alan Garber of Stanford University review the history of two procedures intended to relieve the pain and disability associated with osteoporosis-related vertebral fractures. Based on promising early studies, many insurers had covered these procedures—percutaneous vertebroplasty and kyphoplasty—on an interim basis. But more rigorous CER produced questions about the benefits of both procedures and raised safety concerns, leading to changes in payer coverage policies.

The authors estimate that reducing the utilization of these procedures by 80 percent would save approximately $725 million annually, more than the $500 million projected annual budget of the Patient-Centered Outcomes Research Institute, the entity created by the Affordable Care Act to support CER.


While it will not always yield definitive conclusions, comparative effectiveness research—supported by appropriate payment changes—is a "very good investment for the federal government and U.S. taxpayers," the authors assert.

Publication Details



A. G. Elshaug and A. M. Garber, "How CER Could Pay for Itself—Insights from Vertebral Fracture Treatments," New England Journal of Medicine, April 14, 2011 364(15):1390–93.