U.S. to review effectiveness of treatments
Stimulus will fund research on what works best against specific illnesses.
By ROBERT PEAR New York Times
Posted: Monday, Feb. 16, 2009
WASHINGTON The $787 billion economic stimulus bill approved by Congress will, for the first time, provide substantial amounts of money for the federal government to compare the effectiveness of different treatments for the same illness.
The legislation provides $1.1 billion for researchers to compare drugs, medical devices, surgery and other ways of treating specific conditions. It creates a council of up to 15 federal employees to coordinate the research and to advise President Obama and Congress on how to spend the money.
The program responds to a growing concern that doctors have little or no solid evidence of the value of many treatments. Supporters of the research hope it will eventually save money by discouraging the use of costly, ineffective treatments.
Spending on health care totaled $2.2 trillion, or 16 percent of the nation's gross domestic product, in 2007, and the Congressional Budget Office estimates that, without any changes in federal law, it will rise to 25 percent of the GDP in 2025.
Dr. Elliott Fisher of Dartmouth Medical School said the new money would help researchers try to answer questions like these: Is it better to treat severe neck pain with surgery or a combination of physical therapy, exercise and medications? What is the best combination of “talk therapy” and prescription drugs to treat mild depression?
How do drugs and “watchful waiting” compare with surgery as a treatment for leg pain that results from blockage of the arteries in the lower legs? Is it better to treat chronic heart failure by medications alone or by drugs and home monitoring of a patient's blood pressure and weight?
Britain, France and other countries have bodies that assess health technologies and compare the effectiveness, and sometimes the cost, of different treatments.
Hillary Clinton, as a senator, was an early champion of “comparative effectiveness research.” As Congress translated the idea into legislation, it became a lightning rod for pharmaceutical and medical-device lobbyists, who fear the findings will be used by insurers or the government to deny coverage for more expensive treatments.
Republican lawmakers complained that the legislation would allow the federal government to intrude in a person's health care by enforcing clinical guidelines and treatment protocols.
The money will be immediately available to the Health and Human Services Department but can be spent over several years. Some will be used for systematic reviews of published scientific studies; some will be used for clinical trials making head-to-head comparisons of different treatments.
“The new research will eventually save money and lives,” said Rep. Pete Stark, D-Calif. In the absence of information on what works, he said, patients are put at risk and billions of dollars are spent on ineffective or unnecessary treatments.