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Comparative Effectiveness Should Focus on 'Real World' Circumstances, Policy Consultant Suggests

By Nellie Bristol, CQ HealthBeat Associate Editor

November 7, 2011 -- While some European countries are ahead of the United States in influencing drug prices through judgments on how their effectiveness compares with existing products, they may be making determinations prematurely because they don't adequately take into account patient experiences with the therapies, a health policy consultant said.

Some European countries, including the United Kingdon and Germany, have programs to determine the value added of potential new products, but they largely use only clinical data for the determinations and make judgments when the product is launched, Ian Spatz of Manatt Health Solutions said at a Capitol Hill forum sponsored by the Alliance for Health Reform and The Commonwealth Fund.

That approach, he said, may miss advantages that only show up over time when patients are dealing with their own health care providers and in true life situations. "It's much more complicated in the real world," Spatz said. If comparative-effectiveness determinations are made based only on clinical data, "we could make some substantial mistakes," he added.

International participants at last week's briefing event discussed drug comparisons and pricing in several European countries as well as the United States. Drug prices in the United States are substantially higher than in other member countries of the Organisation for Economic Co-operation and Development, reaching $956 per capita in 2009 versus $750 in the next-highest country, Canada, and a low of $254 in New Zealand.

Comparative-effectiveness efforts bolstered by the stimulus law (PL 111-5) and the health care overhaul(PL 111-148, PL-111-152) give the United States an opportunity to determine which therapies are the most effective and under what circumstances. Spatz said new mechanisms for performing the studies will be useful, but he called on other countries to provide relevant data as well.

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