Feature: Comparative effectiveness research has tough road ahead

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The vociferous backlash that followed the revision of mammography screening guidelines in November 2009 highlights challenges for implementing findings of comparative effectiveness research (CER), according to a new analysis in Academy Health Reports.

CER may be a hard pill for America to swallow. While “the idea of using evidence to improve healthcare policy decisions enjoys [broad] support,” its implementation “can encounter great resistance,” wrote Michael K. Gusmano, a research scholar at the Hastings Center in Garrison, N.Y., and Bradford H. Gray, senior fellow at the Washington, D.C.-based Urban Institute.

With $1.1 billion of the 2009 stimulus package allocated to CER, health policy decision-makers can learn from the ongoing mammo debacle.

“In some ways, this was an unusual case,” said Gusmano in an interview. The timing of the revision was poor with the U.S. immersed in a debate over healthcare reform. “The recommendations provided perfect fodder for critics, smoking gun evidence that the government would put dollars before lives,” he said.

The U.S. Preventive Services Task Force (USPSTF) could have deployed a smarter political strategy, suggested Gusmano, by considering the following questions:

  • Could the release of guidelines be postponed until a more politically amenable time?
  • Was additional public comment merited?
  • How could the task force work with media to build knowledge about the issue?

However, there is no simple ‘bumper sticker’ solution that will lead to unconditional CER acceptance.

“CER is likely to face challenges when findings call for some degree of ‘disinvestment’ – reducing use of an established technology,” wrote the authors. “Some Americans want the latest medical technology no matter what the cost,” added Gusmano.

Building support for CER will require a concerted communications effort. Macro level changes that frame the discussion to consider healthcare costs from the public rather than the individual perspective may help mitigate future PR fiascos and enhance the public’s understanding of the role of CER.

"Establishing broader support for the value of health services research, coupled with sustained efforts to communicate more effectively with the public, is crucial as the U.S. grapples with how best to improve the quality and efficiency of its health system," Gusmano and Gray concluded.