Today, there are multiple treatments for almost every type and stage of breast cancer, leaving patients—and the insurers who cover them—at times with nearly a dozen options to consider. The same goes for certain cardiovascular diseases and a growing list of other ailments. Little wonder, then, that research comparing the effectiveness of various therapies appears to be an idea whose time has come. On August 1, the U.S. House of Representatives passed legislation that would establish a comparative research center to conduct, support, and synthesize research comparing “the full spectrum” of treatments against each other, head to head. As of this writing, the Child Health and Medicare Protection Act with Section 904 containing the research provision still awaits action by the Senate.

 

Swiftly and fairly quietly, a wide range of Congressional advocates, the Medicare Payment Advisory Commission, the Institute of Medicine roundtable, and others have come to surprising agreement on the need for such a center and on many of its main characteristics. The concept, in one form or another, has been endorsed by the presidential campaigns of Senator Hillary Clinton (D-NY), Senator Barack Obama (D-Illinois), and former Senator John Edwards (D-NC).  

 

Nonetheless, the overriding concern of many stakeholders remains: Can such an entity conduct research with the fairness sufficient to ensure credibility, and without becoming merely a cover for cost controls? According to the legislation passed by the House, the comparative effectiveness center would be housed within the Agency for Healthcare Research and Quality (AHRQ), a part of the Department of Health and Human Services already authorized by the 2003 Medicare Modernization Act to conduct comparative effectiveness studies. It would be supported by federal appropriations in the first three years, with gradually increased funding up to $110 million a year in 2010, still less than the cost of a single F-22 jet. To keep it safe from the whims of the annual appropriations cycle in Congress, the center eventually would be funded by assessments on Medicare and private health insurance. That’s in light of the fact that there is a history of professional and industry organizations pressuring Congress to reduce or kill funding for AHRQ and other technology assessment agencies when their analyses touched on financial interests.

 

Proponents emphasize that the center would not do cost-effectiveness research and would not make decisions on payment coverage. But concerns persist. As Sean Tunis of the Center for Medical Technology Policy recently told a conference of biotech executives, “You don’t want the evidence for efficacy to be determined by the payers.”