Will CER Stimulate or Depress Innovation in Healthcare?

With the establishment of the Patient-Centered Outcomes Research Institute in the United States and growth in comparative effectiveness research (CER) worldwide, health care stakeholders are increasingly asking, “How will the implementation of comparative effectiveness research affect medical technology development and innovation?” During a panel session on June 4 at the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) 17th Annual International Meeting, several panelists debated CER’s expected impact: 

• Sean Tunis, MD, MSc, Founder, President, and Chief Executive Officer, Center for Medical Technology Policy (moderator)
• Darius Lakdawalla, PhD, Associate Professor, Price School of Public Policy, University of Southern California
• Sarah Garner, PhD, Associate Director, Research and Development, National Institute of Health & Clinical Excellence (NICE)
• Tomas J. Philipson, PhD, Daniel Levin Professor of Public Policy Studies, Irving B. Harris Graduate School of Public Policy Studies, University of Chicago

Dr. Tunis led the discussion by suggesting that the key issue surrounding CER is striking the appropriate balance between seemingly contrasting forces of strong evidence development regarding risks and benefits, fostering innovation, and containing costs. Subsequently, Dr. Philipson pointed out that CER will likely highlight “winner versus loser” medical technologies, which could have a negative impact on patients and the health care system if payers leave patients who best respond to the "losing" treatment without coverage (see Blue Pill or Red Pill, Philipson's study funded by NPC). Philipson made the case that the real goal of CER is to match treatment to the individual patient rather than simply ranking treatments. It is hard to forecast how consideration of patient heterogeneity will affect treatment development costs, he added.
 
Dr. Lakdawalla discussed the importance of setting up CER policy so it fosters innovation and points to how understanding the disease state affects whether CER pathways should be simple or complex. Closing the discussion, Dr. Garner spoke on her experience with the European cost effectiveness evaluation model through the National Institute of Health & Clinical Excellence (NICE). She mentioned that there are factors that can be used to make the case for or against CER and innovation. She concluded that appropriate questions need to be asked in order to realize the full value of comparative evaluations.