Another Idea Whose Time Has Come in Australia.

As a result of the Obama stimulus package there is an additional important outcome separate from the Health IT initiative.

U.S. to Compare Medical Treatments

By ROBERT PEAR

WASHINGTON — The $787 billion economic stimulus bill approved by Congress will, for the first time, provide substantial amounts of money for the federal government to compare the effectiveness of different treatments for the same illness.

Under the legislation, researchers will receive $1.1 billion to compare drugs, medical devices, surgery and other ways of treating specific conditions. The bill creates a council of up to 15 federal employees to coordinate the research and to advise President Obama and Congress on how to spend the money.

The program responds to a growing concern that doctors have little or no solid evidence of the value of many treatments. Supporters of the research hope it will eventually save money by discouraging the use of costly, ineffective treatments.

The soaring cost of health care is widely seen as a problem for the economy. Spending on health care totaled $2.2 trillion, or 16 percent of the nation’s gross domestic product, in 2007, and the Congressional Budget Office estimates that, without any changes in federal law, it will rise to 25 percent of the G.D.P. in 2025.

Dr. Elliott S. Fisher of Dartmouth Medical School said the federal effort would help researchers try to answer questions like these:

Is it better to treat severe neck pain with surgery or a combination of physical therapy, exercise and medications? What is the best combination of “talk therapy” and prescription drugs to treat mild depression?

How do drugs and “watchful waiting” compare with surgery as a treatment for leg pain that results from blockage of the arteries in the lower legs? Is it better to treat chronic heart failure by medications alone or by drugs and home monitoring of a patient’s blood pressure and weight?

For nearly a decade, economists and health policy experts have been debating the merits of research that directly tackles such questions. Britain, France and other countries have bodies that assess health technologies and compare the effectiveness, and sometimes the cost, of different treatments.

Hillary Rodham Clinton, as a senator, was an early champion of “comparative effectiveness research.” Mr. Obama, who is expected to sign the stimulus bill Tuesday, endorsed the idea in his campaign for the White House.

As Congress translated the idea into legislation, it became a lightning rod for pharmaceutical and medical-device lobbyists, who fear the findings will be used by insurers or the government to deny coverage for more expensive treatments and, thus, to ration care.

Much more here:

http://www.nytimes.com/2009/02/16/health/policy/16health.html?_r=1&em

This article is clearly referring to the National Institute for Clinical Excellence (NICE) in the UK among others.

The organisation can be visited here:

http://www.nice.org.uk/

Now Australia has a good record in developing evidence based guidelines and recommendations and really I see that all this work should continue but that its effect and value would be improved if there were a central evidentiary clearing-house that provided well considered and well reviewed advice available to both clinicians and patients.

The UK initiative – termed NHS Evidence – is another idea that could be usefully reviewed.

See:

http://www.nice.org.uk/aboutnice/nhsevidence/AboutNHSEvidence.jsp

With the work about to be funded in the US, as well as the efforts in the UK, now might be a good time to work out how we can maximally take advantage of, and use, the investments being made!

David.