Editors' ChoiceHealth Care Research

Making Comparative Effectiveness Research Useful

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Science Translational Medicine  06 Oct 2010:
Vol. 2, Issue 52, pp. 52ec155
DOI: 10.1126/scitranslmed.3001752

The recent political milestone of enacting health care reform in the United States has put the field of comparative effectiveness research (CER) front and center. CER—research comparing different health care models for preventing, diagnosing, treating, and monitoring disease—has been touted as a potential solution to the rising cost of health care in the United States. Given this, careful attention is needed in defining “best practices” for how this research should be conducted. A recent report by Tunis et al. and a related Commentary article recommend how to make the evidence gathered by CER of most value.

In their report, Tunis et al. emphasize the importance of involving decision-makers in CER, the best way to fund CER research and infrastructure, and the need to define best analytical practices. The authors point out that a large amount of CER is being conducted on administrative health databases, such as those collected by insurance companies. In a related Commentary article, Rubin notes important points about these types of databases and the most appropriate design and analytical techniques to use with them to ensure that the CER comes to the correct conclusions. Rubin emphasizes the need to carefully define the “causal” question being investigated, to consider which factors predicted the treatment or intervention the patient received in clinical care, and to be realistic about whether the data sets contain the necessary measurements to make valid comparisons between the treatment practices of interest. The take-home message from these two articles is that valuable information can be derived from CER by use of administrative health databases as long as the appropriate statistical design and analyses are applied.

S. R. Tunis et al., Comparative effectiveness research: Policy, context, methods development and research infrastructure. Stat. Med. 29, 1963–1976 (2010). [Abstract]

D. B. Rubin, On the limitations of comparative effectiveness research. Stat. Med. 29, 1991–1995 (2010). [Abstract]

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