Show Me the Evidence: Comparative effectiveness research could aid treatment decisions

A push at the national level to fund more comparative effectiveness research could mean more information for otolaryngologists about which treatments work best for a given condition and in which patients.

The American Recovery and Reinvestment Act (ARRA), passed in February 2009, includes $1.1 billion in funding for this research, which compares the effectiveness of pharmaceuticals, procedures or devices for the same condition. The health system reform bill recently signed by President Obama would create comparative effectiveness research trust funds.

The goal of comparative effectiveness research is to provide physicians and patients with practical information they can use to decide the best treatment option, said Patrick Conway, MD, executive director of the Federal Coordinating Council for Comparative Effectiveness Research. “As a physician, I often don’t have good evidence to guide a patient,” Dr. Conway, a practicing pediatrician, said. “For patients, often the comparative evidence isn’t in existence and so they don’t have the information to make an informed decision.”

Comparative effectiveness research was already conducted by several agencies, including the Agency for Healthcare Research and Quality (AHRQ), but the ARRA increased funding substantially. AHRQ funding for this research, for example, was $30 million in FY 2008. The act provided $300 million.

In June 2009 the council and the Institute of Medicine (IOM) unveiled their priorities for this research, as was required by the ARRA. In its report, the IOM recommended 100 research topics, including the effectiveness of assistive listening devices, cochlear implants, electric-acoustic devices and habilitation and rehabilitation methods for hearing loss in children and adults.

As a physician, I often don’t have good evidence to guide a patient.
—Patrick Conway, MD

‘Real World’ Research

“There are many areas within our specialty that are ripe for comparative effectiveness research, not because there is disagreement necessarily, but because of the innovations and advances in basic science, pharmaceuticals and new technology in our field that have shown great promise,” said David Witsell, MD, MHS, research coordinator to the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. “However, we need to learn more so we can ensure that effectiveness shown in studies links with actual patient profiles seen in practice.”

Both the council and AHRQ have emphasized the need for more cohort studies done in “real world” settings. The idea is not only to get a better grasp of how treatments work, but to learn if some interventions work better than others in certain patient subgroups, such as women, children, minority patients and people with disabilities, Dr. Conway said.