The terms evidence-based medicine (EBM), health technology assessment(HTA), comparative effectiveness research (CER), lack clarity and are often used interchangeably and even carelessly. A new paper by Bryan Luce and my colleagues,1 who comprise the International Working Group for HTA Advancement, argue that this could lead to miscommunication, confusion, and poor decision making. We sought to clarify the definitions and the relationships among key terms and concepts.
We propose an organizing framework presented in the graphic below to demonstrate the differences and relationships among these terms and concepts.
Comparative-effectiveness research is firmly situated in the column “Does it work?” covering both evidence generation and evidence synthesis. EBM is characterized as a decision process, focusing on decisions by individual patients and physicians, but it does cross into the “evidence synthesis” space. Health technology assessment straddles the last two columns in the figure, and is viewed as a method of evidence synthesis that receives inputs from CER, economic evaluation, and the consideration of social, ethical, and legal aspects. As we depict it, HTA is a main input to coverage decisions, which may also be influenced by budget implications.
More specific terminology and concepts are necessary for an informed and clear public policy debate. We hope this figure and paper helps.
1. Luce BR, Drummond M, Jonsson B, Neumann PJ, Schwartz JS, Siebert U, et al. EBM, HTA, and CER: clearing the confusion. Milbank Q 2010 Jun;88(2):256-76.