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Archive for the 'CER' Category

Use Of Comparative Effectiveness Research By Four European Health Authorities

How do different European health authorities use comparative effectiveness research (CER) to determine drug coverage and pricing?  A recent Health Affairs article by Cohen, Malins and Shahpurwala answer just this question.  Here is a table summarizing the mission and priorities of health authorities in England, France, Germany and the Netherlands.   Source: Joshua Cohen, Ashley […]

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Are minimally invasive surgeries worth the cost?

In the past decades, many surgeries have gone from a standard, open surgical approach to a minimally invasive one using laproscopic, endoscopic, and catheter based techniques.  What has been the effect of these innovations on medical spending and employee absenteeism? To answer this question, a paper by Epstein et al. (2013) examines a sample of […]

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Why does comparative effectiveness research fall on deaf ears?

Many of the best practices discovered in the research community are never implemented in practice.  Why is this the case?  One reason is that physicians are overloaded with information and it is costly to cull the literature for best practice information.  This is especially true when best practices are not clearly identified or change over […]

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Setting FDA Standards

To what standard should the FDA hold new drugs?  The FDA has a number of choices.  Drugs companies could be required to prove that the drugs they make: Do no harm. Are more effective than placebos Are more effective than existing drugs Are more cost-effective than existing drugs, or Are both more effective and more […]

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Federal Medicaid Spending: The Worst is Yet to Come

As the economy worsened, Medicaid enrollment has risen.  In the short-run, however, States have been able to avoid large increases in Medicaid spending because the Federal government has footed the tab.  According to the HHS: “Over the past three years, despite rising enrollment due to the economic recession, nationwide State spending on the Medicaid program […]

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Why does cost effective care spread so slowly

According to Fuchs and Millstein, here’s why: Insurers hesitation to standardize coverage.  Standardization of coverage would force insurance companies to compete primarily on the basis of price, which would put pressure on their profits. Employers bear too much of the marginal cost from employees choosing expensive health plans.  Because companies wish to avoid alienating employees, […]

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Who’s running the Patient-Centered Outcomes Research Institute (PCORI)?

As part of Health Reform, the government created the a center to study clinical effectiveness of different health treatments.  This center, known as the Patient-Centered Outcomes Research Institute (PCORI), “does not have the power to mandate or even endorse coverage rules or reimbursement for any particular treatment.”  What leverage does the Institute have?  Not too […]

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Patient Heterogeneity and Comparative Effectiveness Research

According to Kathleen Lohr, the most pressing issues for comparative effectiveness research (CER) include: 1) how to conduct CER for heterogeneous patient populations and 2) ways to implement longitudinal investigations to capture long-term health outcomes.  Today I will focus on measuring patient heterogeneity.  Although it makes sense to take into account differences across patients, measuring […]

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