When it comes to health care, the balance between cost and effectiveness is a difficult one to strike. The injection of $1.1 billion into the US system therefore needs to produce sustainable results.
A middle-aged man appears in a US emergency room complaining of chest pains. Tests show that an arterial blockage is starving his heart of oxygen. He could have treatment A, or treatment B. Which one should he and his doctors choose?
The best treatment, presumably, is the one that is more likely to improve his health. But all too often, medical science doesn't know which one that is. This lack of information persuaded US lawmakers to give $1.1 billion to 'comparative effectiveness' research in the economic stimulus bill last month. Now, health-care policy-makers and researchers must ensure that they make the most of this money.
There is nothing really new about comparative effectiveness research. Defined broadly, it includes anything from literature reviews to head-to-head trials of treatments, drugs, diagnostic procedures or prevention methods. What is new is that the United States is beginning to acknowledge that it needs to do much more of this type of work if it is to mould an affordable, sustainable and effective health-care system.
The new money will be split between the National Institutes of Health ($400 million), the Agency for Healthcare Research and Quality ($300 million) and the Department of Health and Human Services ($400 million). The Institute of Medicine, part of the National Academies, will provide recommendations on how the money should be spent. The agencies must take care to allocate the funding in the most effective way — by focusing on conditions that have the most impact on a population, say, or in which the research will have a real effect on medical practice — not just on those that have the most effective lobbyists. When a clinical trial can cost tens of millions of dollars, $1.1 billion doesn't sound like much.