Saturday, August 15, 2009

Health care re-form VI (Effectiveness)

Part of the answer to higher health care costs is supposed to be the notion of comparative effectiveness research. The "American Recovery and Reinvestment Act of 2009" called for a 15-member Federal Coordinating Council for Comparative Effectiveness Research, and also contained USD 1.1 billion to jump start effectiveness research...

From "Research on the Comparative Effectiveness of Medical Treatments" (48-pg PDF, CBO publication) "Comparative effectiveness is simply a rigorous evaluation of the impact of different options that are available for treating a given medical condition for a particular set of patients. Such a study may compare similar treatments, such as competing drugs, or it may analyze very different approaches, such as surgery and drug therapy. The analysis may focus only on the relative medical benefits and risks of each option, or it may also weigh both the costs and the benefits of those options. In some cases, a given treatment may prove to be more effective clinically or more cost-effective for a broad range of patients, but frequently a key issue is determining which specific types of patients would benefit most from it...

A recent example of a comparative effectiveness study indicates that careful analysis can sometimes disprove widely held assumptions about the relative merits of different treatments. The study, which involved patients who had stable coronary artery disease, compared the effects of two treatments: an angioplasty with a metal stent combined with a drug regimen versus the drug regimen alone. Patients were randomly assigned to receive the two treatments, and although the study found that patients treated with angioplasty and a stent had better blood flow and fewer symptoms of heart problems initially, the differences declined over time. More importantly, it found no differences between the two groups in survival rates or the occurrence of heart attacks over a five-year period"

OK, it will take some time (several years) to do the research, clinical trials, etc. to determine what is effective and what is not, and to amass a significant body of results. Then what? Would the insurance companies be allowed by the government to either refuse payment for treatments deemed ineffective, or to charge higher deductibles and co-pays (both of which are to be capped by the current proposed legislation)? Possibly, possibly not, the track record of Congress is not very good in this regard.

For example, consider drug development and drug trials. There are groups of sick people, who ill and desperate for help, have pushed for access to unapproved drugs still in clinical trials , for access to drugs that have been turned down by the FDA, for experimental treatments, etc. On occasion they have petitioned their representatives, who have then "leaned' on the various agencies and regulatory groups to improve access (regardless of the harm this might do to the approval process, etc.). A sad tale almost always seems to trump the process and the rules... The risk of flagellation as an uncompassionate bureaucrat can be a powerful motivator... but even where it doesn't work why should scientists, researchers, and others be second-guessed by politicians. In fact, following pressure by legislators responding to advocacy groups the FDA is in the process of issuing regulations to increase access to experimental drugs... Why should one expect a different result for treatments deemed either as ineffective, or as being less effective pursuant to the FCCCER?

Previous entries on hospitals & health care:

Health care re-form V (The sales job) - Aug 14th, 2009
Health care re-form IV (What is it?) - Aug 13th, 2009
Health care re-form III (Why we spend more) - Aug 8th, 2009
Health care re-form II (P4P) - Aug 4th, 2009
Health care re-form I (Issues) - Aug 4th, 2009
So? - Jul 27th, 2009
Random chart... - Jul 12th, 2009
Random charts... - May 22nd, 2009
Random chart... - May 9th, 2009
Wyeth v. Levine - Mar 22nd, 2009
Financial crisis & hospitals - III - Mar 22nd, 2009
Random chart... - Feb 1st, 2009
Financial crisis & hospitals - II - Jan 27th, 2009
Random chart... - Jan 26th, 2009
Hospitals' financial update - Dec 25th, 2008
Good for the goose - Dec 11th, 2008
Studies of intererst - IV - Nov 16th, 2008
Studies of interest - II - Nov 16th, 2008
Financial crisis & hospitals - I - Nov 14th, 2008

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