Just weeks after the IOM released its“Top 100” list of agenda items it hopes will drive the Feds’ $1.1 billion comparative effectiveness program, Stanford scientists have weighed in on the matter as well.
In a JAMA editorial, Randall Stafford and colleagues suggest that if comparative effectiveness research is to realize its potential to improve the quality and cost-effectiveness of care, it must focus not just on drugs and devices, but on health-delivery processes and lifestyle practices as well.
Examples of the latter are various diets and exercise programs, as well as alternative therapies that have become popular in the US, according to Stafford’s group.
The group also recommended that comparative effectiveness studies be undertaken earlier on in the life of new drugs and devices. Had such analyses been done regarding the ill-fated pain-killer Vioxx, millions would not have been exposed to its cardiotoxic effects, they say.
In addition, the group said more work needs to be done on translating the results of comparative effectiveness studies to the bedside. “Unfortunately, we still want to believe that information alone will change physician practice,” Stafford told BurrillReport. “There are more potent influences on physicians, including their local culture of practice.”
The scientists also recommend that early-stage drug and device trials feature head-to-head comparisons against already-approved drugs in the same category rather than placebo-controlled trials. This strategy would assure a flow of improved products to the marketplace while driving innovation among drug and device makers.
Lastly, the Stanford group suggests a greater focus on the cost-effectiveness of new therapies, despite methodological problems associated with such evaluations. “What good is comparative effectiveness if it cannot be used to discern anything about value to clinicians, insurers, patients, and society?” they ask.
Glenn Laffel MD, PhD, Sr. VP Clinical Affairs
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