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Comparative Effectiveness Research and Cost-Effectiveness Analysis... What's the Difference?

by Ken Williams
Graduate Special Student
The Johns Hopkins University Bloomberg School of Public Health

Lately, I have had a lot of people ask me about the difference (if there is one) between comparative effectiveness research (CER) and cost-effectiveness analysis (CEA), so I thought that I would take this opportunity to provide a very brief introduction to the subject.

The American Recovery and Reinvestment Act (ARRA) created the Federal Coordinating Council for Comparative Effectiveness Research (Federal Council), which is charged with coordinating the research and guiding the allocation of the money invested in CER by ARRA. In all, $1.1 billion USD has been earmarked for CER with $300 million going to the Department of Health and Human Service’s (HHS) Agency for Healthcare Research and Quality, $400 million for the National Institutes of Health, and $400 million for the Secretary of HHS. With this amount of money on the line, CER has become a very hot topic here inside the beltway.

While there are many definitions of CER out there, the Federal Council, in a report to the President and Congress, provides the following, which serves as an overall guiding definition for the entire federal government:

Comparative effectiveness research is the conduct and synthesis of research comparing the benefits and harms of different interventions and strategies to prevent, diagnose, treat and monitor health conditions in “real world” settings. The purpose of this research is to improve health outcomes by developing and disseminating evidence-based information to patients, clinicians, and other decision-makers, responding to their expressed needs, about which interventions are most effective for which patients under specific circumstances.
  • To provide this information, comparative effectiveness research must assess a comprehensive array of health-related outcomes for diverse patient populations and sub­ groups.
  • Defined interventions compared may include medications, procedures, medical and assistive devices and technologies, diagnostic testing, behavioral change, and delivery system strategies.
  • This research necessitates the development, expansion, and use of a variety of data sources and methods to assess comparative effectiveness and actively disseminate the results.

That is, CER takes evidence-based data about different interventions and seeks to determine the benefits and harms of each as compared to each other.

One of the most important things to notice about the list is that it does not ever mention cost. This is where most of the confusion sets in. In the US, the official CER guidelines, as presented by the Federal Council, do not take cost into consideration as a factor. This is not the case universally, however, as other countries, sub-national governments, and organizations do list CEA as an important component to CER.

As compared to CER, cost-effectiveness analysis (CEA) is entirely focused on the costs of medical and public health interventions. Specifically, CEA will calculate the cost per some measurable improvement (or decline) such as quality-adjusted life years or disability-adjusted life years or the like. While CEA is not included as part of the official US CER guidelines, it is still important to note that CEA can provide valuable supplemental information for decision makers.

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