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Senate Budget Debate Turns to Issue of Health Care Cost-Effectiveness

By Martha Angle, CQ Staff

April 1, 2009 -- Research into the comparative effectiveness—and cost—of different medical treatments, a key issue in the health care overhaul debate this year, jumped to the fore Wednesday during Senate debate of the fiscal 2010 budget resolution.

Senate Minority Whip Jon Kyl, R-Ariz., charged that the Obama administration plans to include cost analyses in comparative effectiveness research to assess the relative usefulness of various options such as drugs versus surgery for the treatment of specific diseases or conditions.

Kyl offered an amendment to the Senate's budget resolution (S Con Res 13) that would expressly forbid Medicare and other federal health programs from using results of comparative effectiveness research to deny coverage of any treatments.

When the Senate votes on that proposal, it may offer an important test of sentiment that could influence the health care overhaul legislation being assembled in two Senate committees.

In a related development, eight Democrats from Senate and House committees with jurisdiction over health introduced legislation designed to provide doctors with unbiased information on all prescription drugs, based on independent, scientific research instead of studies underwritten by the drug companies themselves.

Kyl and his GOP allies said considerations of the relative costs of various treatment options would inevitably lead to rationing of health care.

"Comparative effectiveness research can provide doctors and patients with important information," Kyl said, "but without appropriate safeguards, the government can use it as a tool to ration or deny health care."

Senate Finance Chairman Max Baucus, D-Mont., whose panel is helping to draft this year's massive health care overhaul, dodged the particular question of assessing costs in comparative effective research. But he said, "Controlling costs is part of health care reform. We cannot continue to spend as much as we do on health care. ... We must find a way to contain costs, and part of the solution is reducing unnecessary costs and waste in our system."

Raynard S. Kington, the acting director of the National Institutes of Health, in testimony March 26 before the House Appropriations Labor-HHS-Education Subcommittee, said his agency might use some of the $10.4 billion it received from the economic stimulus package (PL 111-5) to fund comparative effectiveness research that includes cost comparisons.

According to an administration official, the $400 million could be used to fund comparative effectiveness studies that include cost comparisons but the stimulus law would preclude use of these findings by Medicare as the basis of coverage decisions. "In terms of the research that is ongoing at NIH and across the government, the information found in this research is just dispersed to the public for the for their knowledge—there is no requirement to use it," the official added.

Baucus said he understood the intent of Kyl's amendment but considered it unnecessary. He said he was working with ranking Finance Committee Republican Charles E. Grassley of Iowa, Michael B. Enzi of Wyoming, the ranking Republican on the Health, Education, Labor and Pensions Committee, and Orrin G. Hatch, R-Utah, on legislation addressing comparative effectiveness research.

Both Baucus and Senate Budget Chairman Kent Conrad, D-N.D., said Kyl's amendment could potentially require the government to pay for treatments that were ineffective or worse.

Kyl struck back, insisting the aim of the Obama administration was to use comparative effectiveness research to help allocate scarce health care resources "If you don't think anybody's going to try to do it, what's the harm of adopting this amendment?" he challenged.

Prescription Drug Information
Meanwhile, Democrats from key committees in both chambers outlined new legislation to create a source of unbiased information for doctors about the relative effectiveness and costs of prescription drugs - both brand name and generic.

"This bill will provide for objective, scientific reviews of the available evidence on the safety and effectiveness of drugs, and will get this information to the physicians who need it, so they and their patients can make more informed decisions about what is best for their care," said Sen. Edward M. Kennedy, D-Mass., chairman of the Health, Education, Labor and Pensions Committee.

Rep. Henry A. Waxman, chairman of the Energy and Commerce Committee said, "For far too long, most of the information physicians receive to make prescribing decisions has come from the drug companies marketing reps, not independent experts. This important legislation will help provide doctors with the best objective information to help them make better clinical decisions in partnership with their patients."

The bill unveiled by the lawmakers Wednesday would fund grants to academic experts, such as medical or pharmacy school researchers, to develop educational materials for doctors showing the relative safety, effectiveness and cost of prescription drugs, including brand-name products, generic and over the counter alternatives. These materials would include brochures, handouts, and electronic information accessible to both patients and doctors.

Grant applicants could not be recipients of financial support from any manufacturer of the drugs being reviewed.

The bill would also create grants for hiring, training and deploying medical professionals to disseminate and discuss the materials with doctors.

The legislation follows a related bill (S 301) introduced in January by Sen. Herb Kohl, D-Wis., and Senate Finance Committee ranking Republican Charles E. Grassley of Iowa to require manufacturers of drugs, medical devices, and biologics to disclose how much money they give to doctors in direct payments, gifts, honoraria, travel and other emoluments.

Kohl, chairman of the Senate Special Aging Committee, said the latest bill addresses a system "fraught with conflicts of interest."

"By providing physicians with thorough, independent research on all the drugs available to them, we believe we can improve the quality of health care and reduce the cost of prescription drugs in America," Kohl said.

John Reichard contributed to this story.

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