Earlier this year, the U.S. government set aside more than $1 billion to study the pros and cons of health treatments, but it needs advice on how to begin. Today, an expert panel suggested 100 priorities for the so-called "comparative effectiveness research" (CER) funded in the economic stimulus package. The topics, culled from more than 2600 suggestions, range from heart disease treatments to ways to encourage breastfeeding. The report from the Institute of Medicine does not shy away from advising researchers to consider "cost-effectiveness," a term that has raised concern from some members of Congress that it will lead to rationing.
But the panel’s report does not go far in discussing costs; for example, it does not say how research results might be used to decide what health care plans should cover. Making those decisions is "a very big topic and one that we knew we didn't have sufficient time to deal with," says panel co-chair Harold Sox, editor of the journal Annals of Internal Medicine. Sox said some of the 100 studies could be done quickly by drawing on existing data, such as Medicare records. Others will require costly randomized trials.
The panel also urges the creation of an "infrastructure," or CER Program, to coordinate this research across agencies. Various proposals to create a federal center for CER are floating around Congress (here's one example). The recommendations are aimed at the $400 million for CER that the stimulus bill directed towards the Secretary of Health and Human Services. But they could also influence priorities at the department's National Institutes of Health, which received $400 million, and its Agency for Healthcare Research and Quality, which got $300 million in the bill.
—Jocelyn Kaiser
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