Monday, October 11, 2010

Views on CER

A national push on comparative effectiveness research is underway as a result of the federal stimulus and health reform legislation. The research aimed at answering critical questions about what works and what doesn’t in health care, was the subject for the “Health Affairs” briefing “New Era of Comparative Effectiveness Research” (CER) held October 5th in Washington D.C.

The speakers presented their views related to CER concerning the national strategy needed, how the research needs to be designed, the data, and methods to be used, cost effectiveness of care, methods to disseminate research findings, moving CER into clinical practices, how to obtain public support, and how to address the research differences related to a variety of population groups. The speakers ideas presented appear in the numerous articles published in the October “Health Affairs” thematic issue.

What concerns many is how the federal funding available for CER will be spent not only today but in the future. Susan Dentzer, Health Affairs Editor-in-Chief reports that the federal funding for $1.1 billion allocated for CER under the ARRA 2009 stimulus funding has paved the way for a fierce debate over whether any additional backing for the research should be incorporated into the national health reform legislation enacted this year.

Joshua Benner, Pharm.D., Sc.D, Research Director, Engelberg Center for Health Care Reform, at Brookings and his colleagues Marisa R. Morrison, Erin K. Karnes, S. Lawrence Kocot, and Mark McClellan authors of the article “An Evaluation of Recent Federal Spending on Comparative Effectiveness Research” offer early insights into how the new CER funds are being spent along with the priorities and gaps that need to be addressed.

The authors found that nearly 90 percent of the funding allocated for CER will be spent on evidence development and synthesis plus on improving research capacity. More than half of the funds were spent on improving capacity to do CER with projects including evidence development and synthesis, infrastructure and methods development, translation and dissemination, priority setting, and stakeholder engagement.

So far, according to Benner and his colleagues as of August 4th, nearly all of the $1.1 billion was spent, but one of the biggest problems is tracking the grants, contacts, and administrative spending which has proven to be very challenging.

According to the article, the authors consulted several sources for specific information such as: —to examine all open, closed, and archived recovery act funding among HHS sub agencies —to examine all recovery act funding opportunities listed —to consult the section titled “AHRQ and the Recovery Act and also the AHRQ Grants On-line Database (GOLD) —to download summaries of comparative effectiveness projects funded by the NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER). Also reviewed the research, condition, and disease categorization (RCDC) system —to identify project summaries and implementation plans

The authors were able to account for $910.3 million (82.8 percent) of the $1.1 billion available recovery act funds. Breaking the amount down, $298.9 million (99.6 percent) was allocated for AHRQ, $330 million (82.5 percent) for NIH, and $282 million (70.4 percent) for the Office of the Secretary. Of the total, $464.3 million (51 percent) reflects the awarded amounts. However, $446.1 million (49.0 percent) in funding was allocated for specific grant opportunities but these grants have not yet been awarded

Benner reports that this analysis doesn’t account for (17 percent) of the full $1.1 billion in funding because all of the funds have not yet been committed for specific projects. In addition, NIH Grand Opportunity Grants and Challenge Grants are both multiyear projects, but only FY 2009 and some FY 2010 budget information was publicly available.

To complicate the picture, some of the grant information was not available at the time of the publication of the article. In addition, waivers have been approved allowing agencies to spend some of the funds after FY 2010.

As a result, Benner and the other authors, emphasize that since the information is not reported in any central publicly accessible location, it is not always possible to identify all of the funding for the projects. What the authors want to see is a timely comprehensive “dashboard” to provide information on opportunities and ongoing projects, specific aims with priority areas addressed, information on methods and data sources, and budget information with information on the granting agency...

After completing the research, Benner and his colleagues see areas where more funding is still needed to do additional experimental research, to evaluate system-level reforms, to identify the effects in subgroups, and do more research on understudied populations.

The October issue of “Health Affairs” was funded by the National Pharmaceutical Council, WellPoint Foundations, and the Association of American Medical Colleges. For more information, go to or email Sue Ducat at Health Affairs at