The United States federal government will soon release $1.1 billion for comparative effectiveness research.
The United States federal government will soon release $1.1 billion for comparative effectiveness research (CER). The funds are being made available via the American Recovery and Reinvestment Act and will be dispensed by the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality. Oncology providers are generally supportive of this additional funding and 25 oncology groups, including the American Cancer Society and the National Comprehensive Cancer Network, endorsed recommendations for the role of CER in oncology in mid-May 2009. The NIH is developing a strategy for awarding the new funds and on June 30, 2009, the Institute of Medicine is expected to release a Congressionally mandated report that contains funding priorities.
CER in healthcare is a rigorous evaluation of different options that are available for treating a specific health condition for a particular group of patients. The evaluation may include risks and benefits, costs, clinical effectiveness, etc. A key component of this research is determining which patients are most likely to benefit and unlike research studies in which a drug is compared to another drug, CER includes evaluation of different approaches (e.g. surgery versus drug therapy). In oncology, a distinction of CER is its emphasis on effectiveness, or what happens in the "real world," whereas cancer clinical trials have historically focused on efficacy under controlled conditions and within specific populations.
The organization Friends of Cancer Research has prepared a report on CER that is available on its website, www.FOCR.org. The report includes recommendations for CER in oncology, such as linking public and private data, developing guidelines for CER, supporting the development of "personalized" treatment (identifying subgroups of patients who benefit from treatment), and integrating information gained through CER in clinical practice.
Oncology providers need to be aware of the availability of the new funds that may be used for cancer research and understand the basic concepts of CER. One component of CER is looking at outcomes from a variety of perspectives and not just safety and efficacy. Greater emphasis will be placed on the patient's perspective (impact on quality of life and so on) and other aspects, such as cost-effectiveness. Nursing research is well-suited for CER funding and nurses will likely have an expanded role in conducting CER.