Incorporating Comparative Effectiveness Research Results into the U.S. Medicare Program

Abstract

Comparative Effectiveness Research (CER) is a method of evaluation that compares the effectiveness of two or more medical treatments by assessing comparative health outcomes. Historically, there has been a lack of implementation of the findings from CER. Typically, the approval process for a new treatment judges it on the criterion of whether it works efficaciously with little to no consideration of the relative effectiveness with existing treatments. This process for approving new treatments fails to measure how treatments of a similar type perform relative to one another and does not account for the costs of alternative treatments. My primary research question asks how the IPAB can successfully incorporate CER into clinical practice decisions within the Medicare system. I will evaluate this question by looking at the data for three specific medical conditions that will serve as case studies. Specifically, I will examine: 1) the use of stents in the treatment coronary artery disease; 2) knee-arthroplasty; and 3) prostate cancer treatment. I chose these three conditions because they each have extensive CER literature and there are reasonable alternative treatments. Further, the conditions are different in meaningful ways that will make my findings more generalizable. One such way is that intervention is far less discretionary for a patient in need of treatment for a coronary artery blockage, which is life-threatening in an immediate sense. Also, the preliminary literature review suggested that the evidence of clinical benefit for treatments differs significantly between prostate cancer and the other conditions with prostate cancer having much less clarity and many more options. Finally, mortality is not a concern with failing to provide knee-arthroscopy whereas it may occur with failure to treat the other conditions; knee function is purely a quality of life matter.