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Former HCFA Head Proposes Center for Comparing Drugs, Medical Procedures

By Jeffrey L. Austin, CQ Staff

November 7, 2006 -- A center to run trials comparing the effectiveness of drugs and medical procedures would put a check on the rise of health care costs and would promote better health practices, according to an article published Tuesday on the Web site of Health Affairs, a peer-reviewed journal.

Gail Wilensky, former administrator of the Health Care Financing Administration (HCFA), the predecessor agency to the Centers for Medicare and Medicaid Services under President George Bush, argues in the article that a center for comparative effectiveness information would allow the United States to make better coverage and spending decisions. She notes that the United States spends far more money per capita on health care than other developed countries but does not have better health outcomes to show for it. Meanwhile, health care spending is increasing at a rate 2.5 times that of the rest of the economy.

Increased comparisons of medical effectiveness is popular among those who wish to inject more competition into the health care marketplace, but manufacturers in the private sector are wary of results that would narrow treatment options to one or two high performers.

The Food and Drug Administration runs trials on drugs and devices before they are released to the public, but the agency considers their effectiveness relative only to a placebo. Wilensky argues for comparing procedures and drugs against each other.

Wilensky suggested the way forward for such an approach would be apparent once the dust has settled from today's midterm elections.

"The attractive part of this strategy is that unlike some areas in changing health care, it does seem to be less party-specific," she said, noting that the high costs are a natural barrier regardless of the party in power. "It's really a question of trying to get several hundred million dollars allocated to this as opposed to $15 million or $50 million."

The Department of Health and Human Services could create such an agency to run trials, or a freestanding entity, such as a research institute at a university, could take responsibility.

But Wilensky argues in favor of a quasi-governmental agency connected to the federal government but operating independently as a nonprofit. The bulk of its budget would come from congressional appropriations, but it would be able to accept private donations as well. The National Defense Research Institute of the RAND Corporation follows this model regarding defense issues.

In one of the three response articles posted on the Health Affairs Web site, Kathy Buto and Peter Juhn, two health policy directors with Johnson and Johnson, caution that simplistic interpretation of comparative studies' results could lead to a winner-takes-all approach to medicine, when in fact a range of options is needed to tailor treatment to individuals.

"I think some people think, 'Gee, if you do a head-to-head study maybe you could just say, we'll only cover this one treatment and that will save money,'" Buto said. "I think that the real value is going to be in getting good information about when different therapies are appropriate for the right patient."

Yet the authors agreed that the type of center envisioned by Wilensky could be useful, and they supported the kind of public–private partnership she outlined. Such an organization, they argued, could foster buy-ins from the private sector if it included companies and manufacturers in planning and was transparent in its methodology and decisions.

Wilensky is a senior fellow at Project HOPE in Bethesda, Md., which publishes Health Affairs. She wrote her article with a grant from The Commonwealth Fund. She said future articles might outline ways to move her plan forward.

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