Comparative effectiveness research: Promising area of study for pharmacists

Abstract

Listen

Translate article

Comparative effectiveness research (CER)—the comparison of existing health care interventions to give patients and providers unbiased, evidence-based information about relative benefits and harms—has generated a great deal of interest in the health care policy community lately. This is at least partly a result of the American Recovery and Reinvestment Act of 2009,1 which features an unprecedented federal investment in CER. Because it provides generous funding for CER, the recovery act also has served to introduce the research, conceptually, to a public previously unfamiliar with it. This introduction prompted many questions about CER. Will CER affect clinicians’ autonomy and, if so, how? How should research findings affect clinical and payment decisions? Should costs be analyzed? Who benefits and how do they benefit from CER? The pharmacy community has a unique stake in the resolution of these questions because CER confronts issues that are central to the creation and modification of the formulary and because the results of CER often can affect pharmacists’ direct and indirect interactions with patients. As a health researcher, I welcome these questions, as I embrace the opportunity to clear up misconceptions about this important type of research. We can start by defining CER precisely. In a recent report, the Federal Coordinating Council for Comparative Effectiveness Research defined CER as “the conduct and synthesis of research comparing the benefits and harms of various interventions and strategies for preventing, diagnosing, treating, and monitoring health conditions in realworld settings. The purpose of this research is to improve health outcomes by developing and disseminating evidencebased information to consumers, clinicians, and other decision makers about which interventions are most effective for which patients under specific circumstances.”2 Patients are at the center of this definition. This is appropriate because it satisfies one of the Institute of Medicine’s (IOM’s) six aims for a quality health care system as one that is patient centered.3 CER serves its highest calling when it meets the real-world needs of patients. Patients confront health care decisions every day, often without adequate information. For example, when an elderly woman with heart disease seeks the best way to treat the pain from arthritis, an elderly man seeks treatment for depression, or an active middle-aged woman tries to lower her cholesterol, the only question that matters is, “What is the best choice for me?” CER examines different therapeutic, diagnostic, and screening interventions for common conditions by either rigorously evaluating existing scientific literature or generating new findings through scientific studies of different interventions. Its core purpose—determining which treatment works best and for whom—is a fundamental concern for both patients and clinicians when presented with a health problem.