Comparative effectiveness: Common-sense research that saves money, lives

The Problem: Lack of unbiased information on what medical care works best

Each year Americans are spending more on healthcare – about $2.4 trillion last year, more per capita than any other nation – but we’re not getting much better for the money. We rank 29th in infant mortality, 48th in life expectancy, and last of 19 industrialized nations in preventable deaths. It’s estimated that nearly a third of health-care spending is wasted on inappropriate, unnecessary or harmful care.

Our nation’s over-spending and poor health is due, in part, to our failure to determine which treatments work best. When drugs are approved, for example, they’re compared with placebos – they just have to work better than nothing to be sold. Less than 5 percent on all health research goes to directly comparing the effectiveness for certain conditions of drugs, medical products, surgeries and other treatments. Meanwhile, drug and device companies spend billions each year marketing their products to doctors and consumers – biased information with a singular goal of maximizing sales, not making sure people get the most appropriate care.

The Solution: Comparative effectiveness research identifies appropriate treatments
Consumers Union, the nonprofit publisher of Consumer Reports, supports stopping the wasteful use of our healthcare dollars by committing to an independent, adequately funded national research program that uses the most rigorous, open and fair scientific methods to compare the effectiveness and safety of medical treatments. Further, we believe that making the information generated from such research available to doctors and consumers in a timely manner is critical. Right now in our nation, we simply know more about which toasters work best than which drugs or surgical techniques work best.

Comparative effectiveness tells us which options may produce the best outcome for treating a given medical condition. It can compare similar treatments – such as drugs – or different treatments, such as surgery vs. drug therapy. Well-designed comparative effectiveness research can help identify the most appropriate treatment for specific populations of patients. This has the potential to reduce disparities in care often experienced by racial, ethnic and low-income groups, and it is critical more of these populations are involved in the research studies.

Research results can help doctors and patients make better decisions, help reduce treatment implications and hospitalizations, and reduce spending on inappropriate or even harmful treatments. In addition, comparative effectiveness has the potential of leading insurers to make coverage decisions based more on the evidence for effectiveness compared to cost. Absent such information, insurers will continue to make too many decisions based on cost, not which treatment options work best.

Consumers Union, the nonprofit publisher of Consumer Reports, believes that a comparative effectiveness program must 1) be independent and protected from political and corporate pressure, 2) have adequate, stable funding, 3) use rigorous scientific standards, 4) ensure the research includes diverse populations 5) be transparent 6) involve all stakeholders and 7) effectively disseminate findings in ways that are useful to the public.

How much money could be saved?
The estimates vary widely but most experts agree that comparative effectiveness research will, over time, reduce questionable, unnecessary care and improve health outcomes, with both those results yielding potentially billions of dollars of savings a year. Some research and facts already point strongly in that direction:

  • Using scientific evidence and research from the Drug Effectiveness Review Project, Consumer Reports Best Buy Drugs currently compares drugs used to treat 20 common ailments – such as diabetes, heart disease, high blood pressure and depression. Individual drugs are compared on how well they work, how safe they are, and how much they cost. For example, the brand-name heartburn drug Nexium costs about $215 a month, but an equally effective generic nonprescription drug omeprazole (Prilosec), is available for about $14 a month. The cumulative savings can be dramatic – researchers found that if
    Americans taking four medicines for high-blood pressure, heart disease and high cholesterol switched to lower-cost “Best Buys,” more than $2.75 billion would be saved annually.
  • Under Medicare, some areas of the United States spend much more per person than others, but do not generate better health outcomes, even taking the population into account. That led Dartmouth researchers to project up to 30 percent annual savings in our national health costs – or a staggering $700 billion – if practice styles in the lowest- spending parts of our nation are utilized in the rest of the country.
  • The Congressional Budget Office estimated that a 2007 legislative proposal to create a comparative effectiveness research center (costing $2.9 billion over 10 years) would reduce total healthcare spending by nearly $6 billion over the 2008-2017 time period, and much more in the years beyond.
  • Comparative effectiveness can sometimes disprove widely held assumptions about the relative merits of different treatments – such as surgery vs. medications. One recent study of patients who had stable coronary artery disease compared two treatments that differed dramatically in cost and pain: angioplasty with a metal stent combined with a drug regimen, versus the drug regimen alone. The study found that patients treated with costly angioplasty lived no longer nor had fewer heart attacks over a five-year period than those treated much less expensively with fairly inexpensive drugs.

Consumers Union strongly supports efforts to increase funding for comparative effectiveness research in a dedicated program that operates with full transparency, scientific integrity and public input. We believe that such research is a critical component of health reform, serving to better inform providers and patients, thereby enhancing the quality of care while restraining unnecessary costs.

Therefore, CU supports the $1.1 billion for comparative effectiveness research in the current economic stimulus package (American Recovery and Reinvestment Act of 2009) and will support comprehensive reform that establishes an independent entity to conduct this research.

For more information contact:
Adrienne Hahn, Bill Vaughan, 202-462-6262