Government-sponsored research carries high costs

By Robert Goldberg

Published: August 2, 2008

To rein in rising health care costs, many politicians have called on the government to evaluate the relative impact of various drugs and medical treatments.

Notably, Sens. Max Baucus, D-Mont., and Kent Conrad, D-N.D., just introduced a measure to create a government-run "Center for Comparative Effectiveness” to help doctors, patients and insurance providers determine the best possible treatments for a given medical problem.

Getting good value is important. But it's essential that government efforts to weigh the relative merits of various treatment options yield unbiased information. If Washington starts dictating physicians' practices, then patient health will be put in jeopardy.

There's no doubt a CCE could provide vital information. Let's suppose the center conducts clinical trials on two competing cholesterol-lowering medications. One has just entered the market and the other is available as a generic because it's been around for years.

Now imagine that the clinical trials conclude that the newer, more expensive pill is significantly more effective than its older counterpart. For most patients, then, the new pill is worth the price. And if the CCE found that the older drug was better, great — patients would save a few bucks.

Trials like this must be conducted with extreme caution, however, as cost-sensitive governments have a strong incentive to "find” that cheaper treatments are just as good as more expensive ones. Budget-driven bureaucrats might use the CCE's findings to restrict the options available to patients on public insurance programs.

History has shown just how dangerous this approach to medicine can be. Based on state-run comparative-effectiveness trials, Britain's National Health Service has been pushing patients onto a less expensive cholesterol-lowering drug called simvastatin in favor of Lipitor. The British government has probably saved some money. But it came at a cost. An eight-year study found that "major cardiovascular events” had increased by more than a third among patients forced to make the switch.

The British health system has also denied much-needed care to those suffering from rheumatoid arthritis. This spring, it determined that abatacept — a breakthrough arthritis drug — wasn't worth the expense, even though it is one of the few cures shown to provide "clinically significant improvement” for arthritis sufferers.

There are ways to ensure that comparative effectiveness initiatives remain focused on getting patients the best care possible. Doctors should have some say over the research agenda. The data generated by comparative-effectiveness studies should be open to public scrutiny. And findings should be nonbinding.

As politicians grope for ways to control health care costs, they should be sure that their policies don't do more harm than good.

Comparative-effectiveness research has a role to play in fostering more cost-effective use of health resources — but not at the expense of patient care.

Goldberg is vice president of the Center for Medicine in the Public Interest.

As politicians grope for ways to control health care costs, they should be sure that their policies don't do more harm than good. Comparative-effectiveness research has a role to play in fostering more cost-effective use of health resources — but not at the expense of patient care.

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