Health Affairs

Comparative Effectiveness Research: Opportunities and Challenges for the Patient-Centered Outcomes Research Institute in 2012 and Beyond

The December 2011 issue of Health Affairs explores changes needed to ensure that comparative effectiveness research improves patient care, including the challenge of "negative" research findings

Bethesda, MD -- The Patient-Centered Outcomes Research Institute (PCORI) is preparing to review its first round of pilot grant proposals and to release its research priorities in 2012. In an interview published in the December 2011 issue of Health Affairs, the institute's executive director, Joe V. Selby, tells the journal's editor-in-chief, Susan Dentzer, about the organization's near-term work plan--and about how seriously it takes the "patient-centered" focus inherent in its name.

Additional papers in the December issue examine priorities for the comparative effectiveness research in which PCORI will engage. The articles offer recommendations for PCORI's research priorities and outline challenges facing the institute and comparative effectiveness research in general, as follows:

• To have the most influence on real-world health care decision making, Harvard University's Alan M. Garber recommends that PCORI compare interventions on the bases of their clinical risks and benefits, their economic considerations, and the insights they might offer into medical care. He provides an example of how this assessment and rating framework would work by comparing cardiac bypass and angioplasty, common treatments for heart disease.
  
  
• As PCORI begins putting together a research agenda, the National Pharmaceutical Council's Robert W. Dubois and Jennifer S. Graff propose an eight-step framework to guide the setting of research priorities. Critical components include assessing the public health benefits of various treatments and ensuring transparency throughout the priority-setting process.
  
  

• Although two recent clinical trials show that injecting bone cement into the spine to treat painful vertebral fractures does not provide pain relief superior to that of a sham procedure, insurers' coverage of this widely-used treatment--known as vertebroplasty--remains unchanged, according to an analysis by Katharine Cooper Wulff of the Johns Hopkins Bloomberg School of Public Health, Franklin G. Miller of the National Institutes of Health; and Steven D. Pearson of Massachusetts General Hospital. The case of vertebroplasty illustrates why it will be an uphill climb to translate the results of comparative effectiveness research into practice, especially if the research raises questions about established procedures.
  
  

• "Personalized" cancer treatment--using biomarker tests to identify certain genes, proteins, or other indicators that can enable the use of highly tailored therapies--offers tremendous potential for improved outcomes and lower treatment costs. However, the lack of available evidence to support the effectiveness of these tests and the high costs of needed research will require better data collection and creative funding sources, say Scott D. Ramsey of the Fred Hutchinson Cancer Research Center and colleagues.

The articles in this issue are part of Health Affairs' ongoing coverage of comparative effectiveness research; Health Affairs' October 2010 thematic issue focused on the subject.

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically and health policy briefs published twice monthly at www.healthaffairs.org. Read daily perspectives on Health Affairs Blog. Download weekly Narrative Matters podcasts on iTunes.