"One Cannot Measure What One Does Not Manage": Cost-Comparing Treatments (Part XIII-d)

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When attempting to understand "value" in health care reform debate, comparative effectiveness and the cost of different medical treatments becomes a key issue.

When attempting to understand "

" in healthcare reform debate, comparative effectiveness and the cost of different medical treatments becomes a key issue. In "

Senate Budget Debate Turns to Issue of Health Care Cost-Effectiveness" (CQ HealthBeat April 1, 2009),
 a Republican move spearheaded by Senate Minority Whip Jon Kyl, R-AZ, would "expressly forbid Medicare and other federal health programs from using results of comparative effectiveness research to deny coverage of any treatments." They contend that "considerations of the relative costs of various treatment options would inevitably lead to rationing of health care." 
At about the same time, 8 Democrats in several Senate and House committees introduced legislation that would, in effect, circulate unbiased information on prescription drugs that is "based on independent, scientific research instead of studies underwritten by the drug companies themselves."

In my opinion, both are wrong in their approach—short sighted, at best. Clearly, comparative effectiveness research can provide doctors and patients important information, but it is neither a rationing instrument in practice, nor is it the pharmaceutical industry's inability to contribute unbiased information.

In fact, I think we should recognize Pharma when they help us with adherence (read: the 'effectiveness' part). Does the drug work? Is it better than most? You say there's non-compliance? CALL PHARMA! The end game is what works. Cost-effectiveness? That's a bonus. Caveat: cost comparisons are fair game if the drugs have comparable

the capacity to produce an effect and comparable

how well a treatment plan works in practice (the real world).

As a pediatrician, allow me one example—generic cefdinir does not taste as good as brand name Omnicef. Despite the cost differences, some of my patients won't take it. The internists, family practitioners and specialists have their examples, as well—many of them are fighting HMOs every day (it seems) for their favorite drugs on the basis of their experience and their patients' compliance, the HMO P&T committee's pronouncements, notwithstanding.

My point is the treatment that works is the one that is efficacious and is used well.

Take care, and to your health

Angle M. "

Senate Budget Debate Turns to Issue of Health Care Cost-Effectiveness

." The Commonwealth Fund, Pub. Online April 1, 2009

valueefficacyeffectiveness

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