The Way Forward on Comparative Effectiveness

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  • 05/28/2009
Churchill observed: "It is one thing to see the forward path and another to be able to take it."  At The Brookings Institution, CMPI convened the Critical Path for Personalized Medicine, a small group that  took the first transatlantlic steps towards harnessing the science of personalized medicine to the task of controlling health care costs and increasing the value of medical technology that the science itself made possible.  It was lead by two remarkable individuals:  Mark McClellan who ran both the FDA and Medicare and Sir Michael Rawlins, MD who for the past decade has been chair of the British National Health Service's National Institute for Clinical Excellence, the entity tasked with developing guidelines for preventative care and treatment of illnesses as well as evaluating the cost effectiveness of new technologies. 

Sir Michael noted that comparative effectiveness cannot be conducted by relying on randomized clinical trials and should instead use tools that allow doctors to determine who responds best to what treatments over time.  Predictive and interventional approaches are obviously the most valuable. Such tools can provide every one a clearer idea of the value of care. 

Over the course of the four hours we spent together that the way forward requires an approach described artfully by Ralph Snyderman, Chairman Emeritus of Duke University Medical Center:

  • Start with high power predictive tools for big time clinical decions with short term impact on major diseases
  • Create model clinical settings where clinical data and genetic information can be collected and combined
  • Use clinical setting to establish predictive reliability of clinical decision tools and measure clinical outcomes
  • Measure value of such tools to employers, individuals and health plans
   
Ultimately the reimbursement for health care will have to be inverted to pay for prospective care and reward targeted therapies.  

But our critical path group is committed to doing the hard work.  We don't need any more conferences about comparative effectiveness.  We need to take the first steps forward.

CMPI

Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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