Comparative Effectiveness is Limited in Other Countries

Janice Simmons, for HealthLeaders Media , May 20, 2009

If implemented correctly in the United States, comparative effectiveness research could show the capability to improve healthcare and reduce health costs, according to a new report from the Deloitte Center for Health Solutions. However, several barriers—including Americans' distrust of data sources—will need to be addressed in the meantime.

As a point of comparison, the report also looked at three clinical examples of comparative effectiveness studies in four national health programs (China, Germany, Great Britain, and Australia). Those clinical examples were: diagnostic screening detection (colon cancer), medications (the use of statins for treatment of elevated cholesterol), and surgical procedures (treatments for benign prostatic hyperplasia).

The report found that while countries' approaches to comparative effectiveness were instructive, "a cut-and-paste approach" to what works in those countries will not necessarily apply to the U.S., said Paul Keckley, PhD, the centers executive director, in a statement.

For instance, in comparing screening programs for colon cancer, Deloitte noted that while the types of testing used were similar among the countries, broad variations existed in the existence and characteristics of national or regional screening programs.

The report noted that consumers, as primary recipients of healthcare system products, have a large stake in the effectiveness and efficiencies of healthcare services. However, data from Deloitte's 2009 Survey of Health Care Consumers, showed that only 27% said they understood how the health system worked.

In terms of trust, the picture as related to consumers was bleaker. Only 31% of those surveyed said they viewed the federal government—which is a major sponsor of comparative effectiveness research—as a trusted source. Coming before the "government" category in terms of trust sources were associations and societies (51%) and academic medical centers/teaching hospitals (51%). Community hospitals were at 31%.

Comparative effectiveness can be seen as an "engine" for new innovation in the design and delivery of evidence-based care, Keckley said. Healthcare information technology, including electronic health records, "also may play a critical supporting role in its evolution," according to Deloitte.

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at

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