Diverse governmental and non-governmental organizations have publicly expressed their support or reservations about increased comparative clinical effectiveness research. Related Legislation in the 110th Congress

A number of bills have been introduced that support comparative clinical effectiveness research, including several in the 110 th Congress. Similarly, H.R. The Healthy Americans Act, S. 334 and H.R. To help inform the discussion surrounding comparative clinical effectiveness research, this report provides an overview and discusses past and current comparative clinical effectiveness research and other forms of technology assessment in the United States. This report also briefly discusses the use of technology assessment in the U.S. and other countries, and the potential role of a new comparative effectiveness research entity. Past and Current Research Efforts

In order to determine whether and what type of comparative effectiveness research is needed, the scope and scale of current comparative effectiveness research efforts must be understood. Federal Funding of Technology Assessments

Health technology assessment, including comparative clinical effectiveness, cost-effectiveness, and cost-benefit analysis, has been conducted for decades in the United States through both public and private initiatives. The Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health (NIH) are currently the largest federal funders of extramural health technology assessments. Unlike AHRQ and the NIH, the Veterans Health Administration's (VHA) Pharmacy Benefits Management Strategic Healthcare Group (PBMSHG) and the Department of Defense (DOD) PharmacoEconomic Center (PEC) do not out-source their health technology assessments. AHRQ previously sponsored research through its Medical Treatment Effectiveness Program (MEDTEP). The OTA was a nonpartisan congressional agency that conducted health and non-health technology assessments for Congress. Some organizations that have used these assessments include the Academy of Managed Care Pharmacy (AMCP), Consumer Reports' Best Buy Drugs project, the DOD PEC, for-profit firms (including consulting firms, private insurers, and pharmaceutical manufacturers), the Centers for Medicare and Medicaid Services (CMS), the Oregon Health Plan, and the VHA PBMSHG. The entity could also arguably improve researchers' independence and scientific integrity, or spawn the genesis of research not currently being conducted on drugs, other health technologies, or services. These include the Centers for Education and Research on Therapeutics (CERTs), the Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) Program, the Evidence-based Practice Centers (EPCs), and the Research Initiative in Clinical Economics (RICE), which conduct technology assessments, comparative effectiveness research, pharmaceutical outcomes research, and economic valuations of health care services and treatments, respectively. Evidence-based Practice Centers Program. Cost-effectiveness analysis has been used as a research tool in some of the reports.
Comparative clinical effectiveness research has been discussed as a source of information for health care decision makers that may aid them in reaching evidence-based decisions. The premise that "what is newest is not always the best" is the core of the rationale behind comparative effectiveness research. Diverse governmental and non-governmental organizations have publicly expressed their support and reservations about comparative effectiveness research. Many bills have been introduced in the 110th Congress that support comparative effectiveness research, including S. 3, H.R. 2184, H.R. 3162 (CHAMP Act), and the Healthy Americans Act (S. 334 and H.R. 3163). Although publicly supported by many governmental and non-governmental entities in the abstract, controversy about comparative clinical effectiveness research lies in its practice and implementation.
Health technology assessment tools (e.g., comparative clinical effectiveness, cost-effectiveness, and cost-benefit analysis) have been used for decades in the United States. To determine whether and what type of research is needed, the scope and scale of current comparative effectiveness research efforts must be understood. This report summarizes research efforts that have been funded and conducted.
Both the Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health (NIH) provide extramural research funding for health technology assessments. AHRQ's ongoing health technology assessment program includes the Centers for Education and Research on Therapeutics (CERTs), the Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) Program, Evidence-based Practice Centers (EPCs), and the Research Initiative in Clinical Economics (RICE). The Veterans Health Administration (VHA) and the Department of Defense (DOD) also have centers that conduct health technology assessments to help the agencies make formulary and pricing decisions. Health technology assessments by AHRQ's Medical Treatment Effectiveness Program (MEDTEP) and the Congressional Office of Technology Assessment (OTA) were terminated in 1995.
Some organizations that have used these assessments include the Academy of Managed Care Pharmacy (AMCP), Consumer Reports' Best Buy Drugs project, the DOD, for-profit firms (including consulting firms, private insurers, and pharmaceutical manufacturers), the Centers for Medicare and Medicaid Services (CMS), the Oregon Health Plan, and the VHA. Some other countries have given comparative clinical effectiveness and cost-effectiveness more explicit roles in their health care systems.
Proponents maintain that a new comparative clinical effectiveness research entity in the United States could have the potential to increase the efficiency and coordination of research, boost the perceived independence and scientific integrity of the research, or generate research not currently being conducted. Realizing such anticipated gains could depend on many factors. This report will be updated upon legislative activity.