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Comparative Effectiveness an Integral Part of Health Care Overhaul, Experts Say

By Leah Nylen, CQ Staff

October 9, 2008 --Increasing funding for comparative effectiveness projects could save money and improve the safety and quality of the health care system, according to a panel of consumer advocates at an AARP and Consumers Union briefing.

"Comparative effectiveness research should be a building block for health care reform," said Gail Shearer, the director of health policy analysis for the Consumers Union. "We have to improve health care outcomes and get better value for our health care dollar."

Comparative effectiveness initiatives look at various treatments for a particular disorder and compare the options to determine which ones work best for various patient groups.

If instituted, advocates argue that comparative effectiveness initiatives could help reduce health care costs by encouraging doctors to use the best value treatments and medicines. They also would provide greater information to patients about options so they can better participate in making health care decisions.

Marge Ginsburg, the executive director of Sacramento Healthcare Decisions, said any comparative effectiveness initiatives should include the perspective of the average citizen in deciding how health care resources are allotted. Ginsburg conducts research by having focus groups take the position of an insurance company and decide whether, in a given scenario, a patient should receive various treatment options.

When asked if it was legitimate for cost to be considered, 80 percent of participants said it should be a factor in most situations, Ginsburg found.

"Health care is just a quagmire of conflicting values," Ginsburg said. "We need more tools to allow [consumers] to make decisions."

Perry Payne, an assistant research professor of health policy at George Washington University, also emphasized the importance of receiving input from the general community in any comparative effectiveness initiatives.

As an example, Payne cited the example of BiDil, a heart failure drug aimed at African Americans. Because the African American community was generally not aware of the research and development of the drug, many African Americans are reluctant to use the drug, despite the fact that it has shown great results in reducing cardiac deaths, Payne said.

Comparative effectiveness also can help patients make informed decisions about their health, said Jack Fowler, the president of the Foundation for Informed Decision Making. Despite the increased availability of information on the Web, today doctors remain the primary source of medical information for patients, he said.

"Delegating the decision to the doctor is not the best way to make a [health care] decision," Fowler said. "The evidence doesn't tell you what the decision should be. The job of the doctor is in laying out the options."

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