Comparative Effectiveness In U.S. Will Not Be NICE, OMB’s Orszag says
This article was originally published in The Pink Sheet Daily
Executive Summary
The U.S. will not follow the UK’s model of having a bureaucratic organization making cost-effectiveness decisions, OMB director tells Congress.
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White House Office of Management and Budget Director Peter Orszag made it clear that the administration is not looking to build a government entity charged with making cost-effectiveness decisions when reviewing the clinical effectiveness of medical treatments. He testified during a March 4 House Ways and Means Committee hearing that the UK's National Institute for Health and Clinical Excellence is "not the system we will have in the United States." NICE is a UK government-funded agency that sponsors evidence reviews comparing the effectiveness of selected medical technologies and makes coverage recommendations based on its analysis. Cost is among the factors considered when NICE conducts its reviews. Orszag fielded questions on comparative effectiveness and other health care reform-related topics throughout the hearing, which was held to discuss President Obama's fiscal 2010 budget outline (1 (Also see "Republicans Challenge Orszag On Total Health Reform Cost" - Pink Sheet, 4 Mar, 2009.)). He described comparative effectiveness throughout the hearing as a part of the solution to making health care delivery more efficient, with cost savings coming from knowing what works best and being able to offer incentives to use the best options, rather than continuing to pay for the volume of services. The potential for comparative effectiveness research to lead to conclusions about the value of treatments based on their relative cost has been a contentious issue during the debate over health care reform. Language in a report that accompanied the original House version of the American Recovery and Reinvestment Act - which provides $1.1 billion in funding for comparative effectiveness research and creates a Federal Coordinating Council for Comparative Effectiveness - helped fuel concerns that research would be used to make cost-based coverage decisions (2 (Also see "Comparative Effectiveness Funding In Stimulus Bill Raises Some Red Flags" - Pink Sheet, 26 Jan, 2009.), p. 21). The language later was clarified in the compromise version that became law to emphasize that the council's actions should not be construed as mandates or guidelines for payment, coverage or treatment (3 , p. 25). Senate Finance Committee Chairman Max Baucus, D-Mont., also appears to be staying firm in wanting to keep comparative effectiveness research separate from cost-effectiveness analysis when he reintroduces legislation to create an independent public/private comparative effectiveness research entity (4 (Also see "Baucus to Proceed With Public/Private Comparative Effectiveness Vision" - Pink Sheet, 2 Mar, 2009.), p. 3). -Gregory Twachtman ([email protected]) |