Comparison key to lower drug costs, better outcomes

Patients can expect significant savings and better outcomes from their prescription medications when health care professionals use comparative effectiveness research, according to researchers at the University of Illinois at Chicago.

The American Recovery and Reinvestment Act signed by President Obama includes more than $1 billion over the next two years for comparative effectiveness research, a practice that evaluates different options for treating a medical condition among a certain group of patients.

"Despite having the highest per capita health care expenditures in the world, the United States does not always perform well on measures of health compared with other countries," said Glen Schumock, associate professor and director of the UIC Center for Pharmacoeconomic Research.

"With prescription drugs accounting for more than 10 percent -- $227.5 billion -- of the total amount Americans spent on health care in 2007, we need to know more about how drugs compare to one another in terms of effectiveness, safety, and value for money."

The analysis is published in the online version of American Journal of Health-Systems Pharmacy and is co-authored by A. Simon Pickard, UIC associate professor of pharmacy practice.

Comparative effectiveness is a relatively new concept, and it contains two important components, Schumock said. It provides information to help clinicians choose among alternative treatments, and it examines outcomes in actual practice.

Randomized control trials have long been the most widely accepted method to study the efficacy of innovative medical care interventions, and they are required by the U.S. Food and Drug Administration to market a new drug, Schumock said. However, such trials have drawbacks.

A traditional randomized control trial does not show how the drug works, Schumock said, "and it usually compares a new drug with a placebo or an inferior treatment option rather than the drug or drugs that might be legitimate therapeutic alternatives."

The patient populations are also narrowly selected, and are usually healthier than the patients who will eventually use the drug, he said.

Comparative effectiveness studies matches up comparable medications based on current choices available to health care professionals. The patients are those who actually use the drug once it is marketed. The outcomes, Schumock said, are more relevant to decisionmaking at the clinical or policy level.

Comparative effectiveness research may reduce spending on pharmaceuticals and lower overall health care costs, said Pickard. According to the Congressional Budget Office, direct spending by the federal government -- mostly for Medicare and Medicaid -- would be reduced by $100 million from 2008-2012 and $1.3 billion from 2008-2017.

Those figures could be much higher, as they were developed before the recent large investment in comparative effectiveness research, Pickard said.

"With the shared goal of improving decisionmaking at every level of the health care system, pharmacy and other professions can use comparative effectiveness research as an opportunity to be more efficient and more accountable," Pickard said.