Comparative effectiveness research could create imaging technology bottlenecks

The $1.1 billion in the economic stimulus plan committed to comparative effectiveness research may be good for weighing the relative merits of medical technologies, but it could slow their adoption and lead to European-style rationing, according to Obama administration critics.

Yet the first postinauguration reactions to President Barack Obama's commitment to a comparative effectiveness institute have been generally positive. Some sources worry, however, that, instead of helping to streamline healthcare, the move could only make it more burdensome.

The American Recovery and Reinvestment Act of 2009 provided more than $140 billion to healthcare, mostly in benefits for low-income families or those who are losing their jobs during the recession. The law also allocated $19 billion from the healthcare portion to aid the adoption of health information technology and increased by $10 billion the research funding for the National Institutes of Health.

About $1.1 billion will go to the Department of Health and Human Services to jumpstart comparative effectiveness research.

Pending legislation would also establish a Federal Coordinating Council for Comparative Clinical Effectiveness Research made up of 15 members appointed by the president. The council represents healthcare-related agencies such as the Agency for Healthcare Research and Quality, NIH, FDA, and the Centers for Medicare and Medicaid Services.

The final scope and authority of this council is unclear at this point. The possibility that the new council could have the authority to determine whether a technology is cost-effective and grant reimbursement accordingly is troublesome to many, according to Winifred Hayes, Ph.D., president and CEO of Hayes, Inc., a health technology assessment and consulting firm based in Lansdale, PA.

Hayes raised the possibility that comparative effectiveness research could give way to rationing as in several European countries.

"It could be a terrible bottleneck to have one council making those kinds of decisions about the thousands of new technologies that enter the marketplace every year. The second concern is the probability of the politicizing of that process," she said in an interview with Diagnostic Imaging.

An area of interest to radiologists involves head-to-head comparisons of different imaging technologies, such as multislice CT, against the standard of care in several clinical applications. One of the hottest debates to date remains whether CT angiography can replace cardiac catheterization as a diagnostic tool. Comparative effectiveness research may point in that direction, Hayes said.

"I'm suspecting that might be an area of focus in this comparative effectiveness work," she said.

For years, policymakers have weighed the need to use taxpayer money to compare medical treatments or procedures used for same clinical purpose. Congress decided this the time for this approach has arrived and assigned DHHS to fund research comparing drugs, medical devices, and therapeutic interventions. These studies will help establish which are the most effective approaches, she said.

"Comparative effectiveness research is really important in terms of evaluating what we should adopt and how we should use new and existing medical technologies," Hayes said.

Financial concerns that have a vested interest in a growing healthcare economy are partly responsible for the system's inefficiencies and excessive cost. The best available scientific evidence often does not factor into healthcare policy decisions, which is one reason why 30% of healthcare dollars are spent on unnecessary, duplicative, or ineffective services, she said.

It is not in the best interest of the private sector to fix the problem, according to Hayes. That is where the government steps in and assumes a role around comparative effectiveness research that otherwise will never happen.

"We want more than a single drug in a single drug class because not everybody responds to a drug in the same way," Hayes said. "But on the flip side, when you look at new drugs used for the same purpose, if they don't offer measurable improvement over older drugs or devices, there is real justification for saying why should we pay significantly more for those items."

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