Martyn W. C. Howgill, Institute for Health Technology Studies (InHealth)
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.
Written comments of Martyn W. C. Howgill, executive director of the Institute for Health Technology Studies (InHealth) to the public meeting of the National Advisory Council for Healthcare Research and Quality, Friday, April 3, 2009.
On behalf of InHealth, the Institute for Health Technology Studies, I wish to thank the National Advisory Council for Healthcare Research and Quality for the opportunity to comment on the investment of the American Recovery and Reinvestment Act of 2009 in AHRQ's comparative effectiveness research program.
InHealth is a 501c(3) research and educational foundation focused on measuring the value of medical technology innovation. Since its establishment five years ago, InHealth has funded more than a dozen studies by university-level researchers on topics ranging from the value of clinical laboratory diagnostics to the comparative benefits of drug-eluting stents over their bare-metal counterparts. To date, these studies have resulted in 13 articles in peer-reviewed journals, making a significant contribution to our understanding of the value and appropriate applications of medical technologies.
Because our organization's mission has many points of contact with the work of the Agency for Healthcare Research and Quality (AHRQ), we understand the importance of the $1.1 billion that the recovery act has provided in support of comparative effectiveness research. Divided as it is—with $300 million allotted to AHRQ, $400 million to the National Institutes of Health, and $400 million to the secretary of Health and Human Services—there is good reason to believe that the funding will support research into a wide range of important areas.
Even so, government agencies cannot be expected to conduct all of this research themselves. In fact, Congressional intent would seem to be quite the opposite: the recovery act prohibits AHRQ from spending more than 1% of its funding for additional full-time equivalents.
There is another reason that government agencies should not become the sole repositories of information about the comparative effectiveness of medical diagnostics and treatments. Scott Haig, MD, an assistant clinical professor of orthopedic surgery at Columbia University College of Physicians and Surgeons, expressed this view in a recent Time editorial (April 6, 2009; pg. 48). Arguing against the rise of electronic medical records, Haig comments:
Crunching huge amounts of data from a wide cross section of patients could help us do better research than we are doing now. But what will happen when the new computerized research turns up a treatment that works a little better but costs a lot more? Will the government-sponsored researchers tell us? What happens to the patient whose particular circumstances argue for a different treatment from what the computers and bureaucrats recommend?
One solution to this conundrum will be for the government agencies charged with administering recovery act funds to ensure that the research they support represents the broadest possible spectrum of topics and approaches relevant to the goals of comparative effectiveness research.
In light of these observations, we encourage AHRQ to take full advantage of its authority under the recovery act to make grants and enter into contracts with appropriate entities—including private sector entities—that have "demonstrated experience and capacity to achieve the goals of comparative effectiveness research."
We further encourage AHRQ to consider the creation of a matching grant program for appropriate research organizations, thereby helping to stimulate further investments in healthcare research. A matching grant program could potentially double the impact of the federal dollars being invested through the recovery act, enabling qualified entities to quicken the pace of their research into the comparative effectiveness of medical technologies, and to take on areas of research that might not otherwise rise to the top of the agency's list of priorities.
On behalf of InHealth, I thank you for your attention.
Martyn W. C. Howgill
1319 F St. NW, Ste. 400
Washington, DC 20004
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