Is comparing medical treatments akin to 'rationing' care?

The Senate Health, Education and Labor bill would also create a new federal entity, though with a different name: the Center for Health Outcomes Research and Evaluation.

It also would be charged with conducting its own studies, as well as synthesizing research done by others. Its charge: give providers and patients information on the “most effective therapies” for preventing and treating health conditions.

Many physicians believe the value of such research is obvious. Why waste money on treatments that don’t work – or, at least, don’t work as well as they should?

Right now, most medical research focuses on randomized clinical trials of new drugs, devices, or treatments, points out a recent analysis of the subject published in the New England Journal of Medicine. Much less time and money are devoted to comparing current treatments with one another.

But health policymakers, insurers, and health providers are increasingly interested in just such comparative research.

“The need for CER [comparative-effectiveness research] is clear,” says the analysis, written by physicians Aanand Naik and Laura Petersen. But Drs. Naik and Petersen note that currently there is little established evidence that actually shows comparative effectiveness research can change physician behavior and improve patient care.

And political opponents of the current healthcare reform bills charge that the research could even be the first step to government allocation of healthcare resources.

In the British national health service, a government board approves only expensive treatments that add at least the equivalent of one year of quality life for every $50,000 in spending, pointed out Harvard economist Martin Feldstein, former chief economic adviser to former president Ronald Reagan, in an August opinion piece on the subject.

In the US “comparative effectiveness could become the vehicle for deciding whether each method of treatment provides enough of an improvement in health care to justify its cost,” writes Feldstein.

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