The CEA Registry Blog

Mar 12

by CEA Registry Team 3/12/2012 11:26 AM  RssIcon

The Patient-Centered Outcomes Research Institute (PCORI) is a non-profit organization that was created during health reform (1) to fund a new brand of outcomes research - research explicitly designed to help patients and clinicians choose among alternative healthcare treatments and strategies. In one of its first key activities, PCORI developed a set of five draft priorities for this new research approach,(2) and it is inviting the public to submit comments on them until March 15. 
The draft priorities reflect some careful considerations, including such important topics as improving health care systems, addressing disparities, communicating and disseminating research, and addressing methodological research.
However, some aspects of the health reform law that created PCORI make the inclusion of information on the costs and value of health care problematic. (3,4)  For example, the law bars the Secretary of Health and Human Services from using cost per QALY thresholds in coverage determinations.  It goes further and says that PCORI-funded research may not be used as the “sole basis for denying coverage for items or services.” (1)
These prohibitions are somewhat difficult to interpret. The draft priorities appear to dodge this difficulty entirely by omitting overt references to the costs and value of healthcare. 
The priorities document does invite the consideration of “patient-centered outcomes.”  Essentially, if patients say a research outcome is important to know about, it qualifies as a research priority. 
Plenty of evidence suggests that costs do matter to healthcare decision-makers, especially patients. (5) In particular, the first two PCORI priorities (listed below) are aimed at clinical research and health systems research, both of which would be improved if the priority mentioned the centrality of costs in healthcare decisions.
1. Assessment of Prevention, Diagnosis, and Treatment Options. Research should focus on 1) clinical options with emphasis on patient preferences and decision-making, 2) biological, clinical, social, economic, and geographic factors that may affect patient outcomes.
2. Improving Healthcare Systems. Research should focus on 1) ways to improve access to care, receipt of care, coordination of care, self-care, and decision-making, 2) use of non-physician healthcare providers, such as nurses and physician assistants, and the impact on patient outcomes, 3) system-level changes affecting all populations, diseases, and health conditions.
In priority #1, notably, no mention is made of research on tradeoffs among healthcare options where resources are limited.  Similarly, for priority #2, there is no mention of the comparative value of healthcare strategies and policy.  Both would be improved by more direct acknowledgement of cost issues.
By Tom Concannon, Ph.D. and Peter J. Neumann Sc.D.
1.  “The Affordable Care Act, Section by Section.”  Available here.  Accessed on March 11, 2012. 
2. Patient-Centered Outcomes Research Institute.  “National Priorities for Research and Research Agenda.”  Available here.  Accessed on March 11, 2012. 
3. Neumann PJ.  What we talk about when we talk about health costs.  N Engl J Med.  2012;366(7):585-86. Available here.   Accessed on March 11, 2012. 
4. Garber, AM.  A menu without prices.  Ann Intern Med. 2008; 148:964-966.  Available here.  Accessed on March 11, 2012. 
5. Agency for Healthcare Research and Quality.  “Study Finds Consumers Choose High-Value Health Care Providers When Given Good Cost and Quality Information.”  March 5, 2012.  Available here.  Accessed on Marched 11, 2012.


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