James A. Rollins,VCU Health System
On April 3, 2009, public testimony on comparative effectiveness
research was given at a meeting of the National Advisory Council
for Healthcare Research and Quality. The testimony represents
the views of the presenter and not necessarily those of the Agency
for Healthcare Research and Quality (AHRQ) or the Department
of Health and Human Services (HHS).
The Council provides advice and recommendations to the Director,
AHRQ, and to the Secretary, HHS, on priorities for a national
health services research agenda.
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As a former Medical Director of a large commercial insurance plan responsible for policy development of new emerging technologies, it would have been helpful to be able to access a credible, non-bias source to help in determining the effectiveness of a new technology in comparison to existing technologies. Though most insurers profess to using evidence-based medicine in making these decision, our conclusions are not consistent. Most of the studies in the medical literature provide proof that a technology is more effective than the placebo. That is a low hurdle that even a marginal technology can achieve. What is more important, not only from an insurer's perspective, but also from a societal perspective is to identify those technologies which are not just better than placebo, and which are not just incrementally better than other technologies used for the same condition, but also are substantively better. I think that the adoption of a comparison effectiveness effort on behalf of appropriate federal agencies could help us to achieve these goals. New technologies are ever increasing, and cost associated with them could be incredibly high. But when looking at technologies, we must ask ourselves, how much does it contribute in terms of diagnostic value? How much does it contribute in terms of management value? Bayesian as well as Decision analysis should be considered. We need to take a pro-active stance and begin to identify those technologies which will help us, and incorporate them into our decision-making process. AHRQ seems to be in a perfect position to accomplish this goal (more so than NIH), since AHRQ is more involved in the
delivery aspects of care, more so than the basic sciences which is the hallmark of NIH.
James A Rollins, MD, MSHA, PhD
VCU Health System
http://www.vcuhealth.org
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