Survey of Comparative Effectiveness Studies: Major Gaps

A paper and an editorial in the most recent JAMA (subscription required) depict the current status of comparative effectiveness research (CER). Drs. Conway and Clancy of DHHS/AHRQ summarize the findings in the paper by Drs. Hochman and McCormick of Harvard. The latter looked at the 6 highest-impact general and internal medicine journals between June 1, 2008 and September 30, 2009. They evaluated 328 studies that looked at medications, and found that 104 of them were CER. They noted at only 11% of these CER studies compared medications with nonpharmacologic interventions, while 31% compared different pharmacologic strategies. Another major gap was that only 19% of studies focused on safety of medications. Only 13% of the CER was commercially funded.

Conway and Clancy note that federal funding for CER has recently increased as a result of the economic stimulus package. They also suggest what steps must be taken in the future to get the most out of CER. I am certainly no expert in this field but to me, what their comments suggest is the need in CER for something like the international Cochrane Collaboration for systematic reviews of the medical literature. That is, a coordinating body or clearing house that can assure reasonably uniform and high-quality methods, and identify areas needing study and areas where overlapping studies may be underway, is highly desirable. They mention the Federal Coordinating Council for Comparative Effectiveness Research and the Institute of Medicine as possible locations for this activity.

One thing that Conway and Clancy did not mention perhaps deserves comment--they say nothing in their editorial about linking CER to issues of cost of care or cost-effectivess. This may reflect fears of the Obama Administration over stoking any talk of healthcare "rationing" as the fight over health reform legislation intensifies. For the record, Hochman and McCormick noted that only 2% of the studies they surveyed addressed cost-effectiveness.

Hochman M, McCormick D. Characteristics of published comparative effectiveness studies of medications. JAMA 303:951-958, 2010.

Conway PH, Clancy C. Charting a path from comparative effectiveness funding to improved patient-centered health care [editorial]. JAMA 303:985-986, 2010.