Comparative Effectiveness Research and The Patient -- Burt's Stent Blog "The Voice in the Ear"


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May 1, 2009 -- 4:30pm EDT

Comparative Effectiveness Research and The Patient
U.S. Capitol More than a billion dollars has been allocated to "Comparative Effectiveness Research" in the U.S. Federal government's stimulus package, yet the term continues to be confused with "cost-effectiveness". They are not the same, and in an attempt to clarify the difference, Angioplasty.Org will be posting a number of articles and interviews in the near future about these issues: specifically how they impact the field of interventional cardiology.

But in the short term, here are a few quick looks.

In March we posted an article about the SYNTAX study which compared bypass surgery to stenting in multivessel disease. The results were not a "yes or no", but more nuanced. Surgery was still the preferred treatment for patients with severe multivessel disease. But for patients with less severe situations, stenting was just as effective ("comparative effectiveness") -- in fact, the authors cited patient preference as an important decision factor. We quoted Dr. Elizabeth Nabel, Director of the National Heart, Lung, and Blood Institute (NHLBI):

This study is an example of Comparative Effectiveness Research which is...a rigorous evaluation of two different types of treatments... towards the same medical condition. And it evaluates the effectiveness of both those approaches.

It may be that what we're coming down to is a discussion between the patient and the medical and surgical team, really focusing on patient preferences, complexity of coronary anatomy and potential risks and benefits, depending upon their medical state and their co-morbidities.

This concept of a partnership between the patient and physician is echoed in an op-ed piece in today's Baltimore Sun by Ruth R. Faden and Jonathan D. Moreno. Titled "Power for Patients: Comparative effectiveness research will help people make better health choices", the article emphasizes the importance of patients' control over their treatment, but in tandem with their physicians, and based on the most current information:

Critics charge that comparative effectiveness research will lead to "one-size-fits-all" guidelines that cater to a non-existent average patient for the sake of making the system more efficient. In fact, patients will be empowered by rigorous, evidence-based recommendations that are specific to the needs of particular patient groups. Research on comparative effectiveness would provide data to help each patient make the best possible choice with his or her doctor.

Patients want the right to make decisions with their doctors in order to pursue what is in their own best interests. Choosing blindly is an empty right; choosing with evidence respects patients' rights and enhances quality. This is a case in which good ethics demands good facts.

We at Angioplasty.Org concur. Each month, 30,000 readers visit our Cardiology Patients' Forum, looking for the latest information to help them make complex decisions. We always encourage those readers who post questions to discuss the information they find with their physicians.

One thing we have found, and this is backed up by research:

Online health seekers, particularly those faced with chronic diseases, want access to the type of in-depth information their doctors read, they want the latest news on the latest studies, they want to know what top doctors recommend.

That is why, at Angioplasty.Org, all of our articles are available to all readers, whether patients or healthcare professionals -- to help foster the partnership that is so critical for "effective" treatment.

Comparatively speaking, that is.

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