The economics of comparative effectiveness research

Abstract

Comparative effectiveness research (CER)—evidence that compares alternative methods of prevention, diagnosis, treatment, and monitoring or care delivery1—holds the promise of improving care and reducing health care costs. In this issue of Neurology ®, French and England2 highlight how CER can improve care by informing clinical practice and guideline development. Here we examine whether and how CER may affect both the level and growth of health care expenditures. In 2008, the United States spent more than $2.3 trillion or over 16% of its gross domestic product on health care,3 far more than any other country. However, by many health metrics, the United States lags behind its peers.4 Maximizing the value of health care expenditures, the majority of which goes to health care delivery,3 is thus an important objective, but to date only 0.1% of health care spending has been devoted to research aimed at improving health care delivery.5 This funding may increase; the Institute of Medicine identified health delivery as the top priority for $1.1 billion of new federal funding for CER as part of the American Recovery and Reinvestment Act of 2009. By identifying cost-effective ways to deliver care, CER may reduce the level of health care spending. Delivering health care to those with neurologic …