Stimulus funds force hard look at comparative effectiveness research.

T wo much-anticipated national reports on comparative effectiveness research appeared at the end of June, a first step toward spending the economic stimulus funds intended to compare different medical interventions, improve medical care, and ultimately help contain health care costs. Of the $1.1 billion in the American Recovery and Reinvestment Act allocated to comparative effectiveness research, the Office of the Secretary of Health and Human Services receives $400 million, the Agency for Healthcare Research and Quality (AHRQ) receives $300 million, and $400 million will go to the National Institutes of Health. The National Cancer Institute and other institutes at NIH hope to fund grants from the shared pot of money. But before that can happen, policy leaders need to decide just what constitutes comparative effectiveness research. Even with the new reports — one from the Institute of Medicine (IOM) and one from the Federal Coordinating Council for Comparative Effectiveness Research – that remains a surprisingly open question. " Comparative effectiveness research are three words that people have put together and decided sound great, " said Otis Brawley, M.D., chief medical offi cer of the American Cancer Society. " It is the trend right now. The general concept is that we frequently have more than one treatment and we don't know which one is better. We need to compare them so we can use what is, fi rst, the most effective and, second, the cheapest. Beyond that, the defi nition gets mud-died because people take it to mean much more specifi c things that are incredibly different. " The defi nition that has emerged from the two groups are broad and do not include cost effectiveness as a necessary component. They do emphasize, however, head to head comparisons of interventions and strategies — not necessarily treatments — and studies conducted in real-world populations, typical of physicians ' practice. The IOM also selected 100 current priorities for comparative effectiveness research, including seven that relate to cancer (see sidebar, p. 1039). At a press conference, Harold Sox, M.D., editor of the Annals of Internal Medicine , and co-chair of the IOM committee , said the criteria for selecting priorities included three key elements: a focus on comparing active interventions ; evaluating effectiveness in typical practice settings; and identifying what patient characteristics would predict benefi t. With general defi ni-tions and priorities supplied by the two reports, the momentum now moves to the Offi …