Maximizing the Impact of Comparative Effectiveness Research: The Role of the DEcIDE Consortia

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Maximizing the Impact of Comparative
Effectiveness Research The Role of the DEcIDE
Consortia

• Scott R. Smith, PhD
• AHRQ Center for Outcomes Evidence
• US Department of Health Human Services

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Effective Health Care (EHC) Program, 2003
Present

• Authorized in 2003 by Section 1013 of the
  Medicare Prescription Drug, Improvement, and
  Modernization Act
• Conducts objective comparisons of the
  effectiveness of different health care
  interventions
• Goal To support informed health care decisions
  by patients, clinicians, and policymakers and
  improve the quality, effectiveness, and
  efficiency of health care to support
  evidence-based practice

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Effective Health Care Program

• Evidence synthesis (EPC program)
• Systematically reviewing, synthesizing, comparing
  existing evidence on treatment effectiveness.
• Identifying relevant knowledge gaps.
• Evidence generation (DEcIDE, CERTs)
• Development of new scientific knowledge to
  address knowledge gaps.
• Accelerate practical studies.
• Evidence communication/translation (Eisenberg
  Center)
• Translate evidence into improvements
• Communication of scientific information in plain
  language to policymakers, patients, and
  providers.

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CBO Comparative Effectiveness Definition

• Comparative Effectiveness
• a rigorous evaluation of the impact of
  different options that are available for treating
  a given medical condition for a particular set of
  patients.

Congressional Budget Office, 2007
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Priority Conditions for the Effective Health Care
Program

• Arthritis and non-traumatic joint disorders
• Cancer
• Cardiovascular disease, including stroke and
  hypertension
• Dementia, including Alzheimers Disease
• Depression and other mental health disorders
• Developmental delays, attention-deficit
  hyperactivity disorder, and autism

• Diabetes Mellitus
• Functional limitations and disability
• Infectious diseases, including HIV/AIDS
• Obesity
• Peptic ulcer disease and dyspepsia
• Pregnancy, including pre-term birth
• Pulmonary disease/Asthma
• Substance abuse

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Available EHC Products
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Evidence Generation

• DEcIDE (Developing Evidence to Inform Decisions
  about Effectiveness) Network.
• Capitalizing on data
• New methods
• Answers for questions that dont require
  multi-year, multi-million trials

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What Does DEcIDE Primarily Do?

• Analyze existing health care databases to compare
  the effectiveness outcomes of treatment.
• Analyze existing disease, device, and other
  registries.
• Conduct methodological studies to improve
  research on clinical effectiveness of treatments.

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Summary Unofficial DEcIDE Statistics

• 13 DEcIDE centers.
• Over 60 core clinical scientists.
• Over 500 affiliated personnel.
• Access to gt120 different health databases.
• Health data on over 50 million Americans.
• Nations largest network of researchers in
  therapeutic effectiveness.

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AHRQ DEcIDE Research Centers
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DEcIDE Focus Areas in Comparative Effectiveness
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Comparative Effectiveness
and the Recovery Act

• The American Recovery and Reinvestment Act of
  2009 includes 1.1 billion for comparative
  effectiveness research
• AHRQ 300 million
• NIH 400 million (appropriated to AHRQ and
  transferred to NIH)
• Office of the Secretary 400 million (allocated
  at the Secretarys discretion)

Funding for health IT, prevention and other areas
could have implications for the Agency
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Todays Speakers
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Recovery Act Timeline AHRQ
May 1 Due date for Agency wide and
program-specific Recovery Act plans
July 30 AHRQ to submit FY 09 Operations
Plan
December 31, 2010 All Recovery Act funding to be
obligated
February 17 The American Recovery and
Reinvestment Act of 2009 is signed into law
2009
January
April
July
October
2010
November 1 AHRQ FY 10 operations plan
due
March 19 Establishment of Federal Coordinating
Council for Comparative Effectiveness Research
June 30 Due date for IOM submission of a list of
national priority conditions
Stakeholder input required
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CER Moving Forward
Issues to Consider

• Comparative Effectiveness is a useful tool in a
  much larger toolkit it is not the answer
• Comparative Effectiveness does not make policy or
  health care decisions, tell doctors how to
  practice medicine or make final decisions about
  what kind of treatments insurers will pay for
• Comparative Effectiveness does weigh the evidence
  and present it in a way that helps consumers and
  their doctors make the best possible decisions
  about health care choices

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The Future

• Public-private funding and participation likely a
  necessity
• More effort to get better conditional
  reimbursement study designs/protocols
• Patients should be engaged as partners at the
  local and national levels
• Need to tackle important issues
• Ethical
• When to know when the evidence is sufficient
• Transparency
• Setting priorities