Recognizing the urgency to fix the escalation of care costs, health care reform may soon define “right care” in part by how much that care costs and to what extent it guarantees patients' best interests. Yes, I am talking about the advent of comparative effectiveness research in wake of U.S. health care reform. Hopefully with this, every American will enjoy a pragmatic shift in their care services, more centered towards “personalized” medicine.
In theory comparative-effectiveness research sounds academic; but in practice it’s an analytical tool that helps physicians in evaluating different therapeutic options and spot the one which will work best for a patient. If we look at all the Western nations that have instituted health care reform, comparative-effectiveness research in some form has played a central role in nudging their existing system toward efficiency. Now, it’s our turn to foster this intelligence tool and improve the quality of care.
In this era of advanced medicine and technology, when physicians are less indulgent in prescribing the cheaper diuretics over the expensive ACE inhibitors, calcium-channel blockers, and beta-blockers in hypertensive patients, or advising invasive CT scans in place of more expensive MRIs in diagnosing subdural hematomas, comparative-effectiveness research stands as a lead in justifying all such approaches. Even against all “blind” cost containment principles--“best practices are always the adoption of least expensive approaches”. Comparative effectiveness research provides the right directives--such as implantation of expensive ICDs in patients with acute MI over optimal medication therapy, with its power to equate a therapeutic approach with cost per life-year gained/QALY (Quality Adjusted Life Year).
In spite of all these, unfortunately there is still widespread ignorance and debate about what comparative effectiveness research will do in our existing health care industry:
1. Will it be a bureaucratic decision to determine when, how, and whether one will receive care?
2. Will it be a tool to determine coverage decisions?
3. To what extent will this result in federal control over the doctor/patient relationship?
4. How much will it take away physicians’ clinical autonomy?
5. What will be the fate of all those trusted treatments that are practiced to date?
I feel that there is no reason to be so short-sighted. Americans should hardly panic since changes in coverage and care delivery will always be driven by knowledge about what is valuable to preserve in our health care system. Comparative effectiveness research is just a stimulus for right, cost-efficient clinical decision making. The above questions are just a few that will be addressed in a debate that will continue until the benefits are reaped.
Rajiv Sabharwal is the chief solution architect in the Healthcare and Life Sciences unit at Infosys Technologies LTD. He can be reached at Rajiv_Sabharwal01@infosys.com.
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