Comparative Effectiveness Not Healthy

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The system of comparative effectiveness, the study of how cost effective drugs are, is ruining health care, according to several medical experts at a panel sponsored by the Galen Institute. The panel concluded that comparative effective studies don’t save money, insert politics unnecessarily into the decision of healthcare, and don’t provide very good outcomes.

• Scott Gottlieb, of the American Enterprise Institute, stressed the difficulty of conducting comparative effectiveness studies. In order to be authoritative, such studies need to have a large number of participants, which makes them expensive to conduct. Also, to be authoritative, more than one study is needed. The need for studies delay access to life-saving medicine, Gottlieb believes. He added that comparative effectiveness studies such as those used in the United Kingdom would reduce the development of new cancer drugs. A resident fellow at AEI, Gottlieb is also a practicing physician.

• John Bridges, associate professor at Johns Hopkins University, also agrees that comparative effectiveness studies delay access to life-saving drugs, adding that “There is no evidence that comparative effectiveness finds better solutions to healthcare.” The delay caused by the need for studies reduces the lifespan of patents, and thus reduces the incentive to develop new drugs. Bridges recommends a system instead where patients are involved in making drug-choice decisions, though he didn’t specifically describe what it was he advocated.

• Michael Schlander, a physician and an economist at the University of Applied Economic Sciences, said that the effort to define and assign a price to a “quality adjusted life year,” which is the basis of comparative effectiveness, is fraught with difficulties. First he said that it was difficult to assign a dollar value to a year of life. Schlander said it was also difficult to figure out exactly how each kind of disability subtracted from that. He also said that by using comparative effectiveness, drugs for rare diseases which don’t have a lot of patients wouldn’t be developed because the costs wouldn’t justify the small populations they would help. Schlander concluded by saying that Germany had determined that they couldn’t assign a dollar value to a year of life.

• Karol Sikora, a physician with the Imperial College School of Medicine, said that

“Cost effectiveness is causing complete chaos in [the British] health system.” Bureaucrats oppose paying for some drugs which could help people as a means of keeping down costs, and when they do approve drugs there is an inevitable delay. Cost containment has radically reduced innovation in the development of cancer drugs. Politicians decide to favor some drugs over others for political purposes (though what this statement has to do with arguments for or against comparative effectiveness is unclear). Sikora thinks that in the future patients will be given a specific budget and the freedom on how to spend it.

• Brett Skinner, of the Canadian Fraser Institute, says that it takes Health Canada, the Canadian health care service, two years to approve a new drug. Less than half of all new drugs get approved on the federal level, and even those approved on the federal level can and do get vetoed for reimbursement on the provincial level. Skinner blasts comparative effectiveness as a “one size fits all” regime that treats all patients the same.

He adds that that comparative effectiveness hasn’t significantly reduced the cost of prescription drugs, compared to what is spent in the U.S. Skinner worries that this centralized approach to health care, while not reducing costs, may actually have worsened healthcare for some.