Report faults health research institute
Facility spends only half of federal funds to compare treatments
An institute that pays researchers to compare medical treatments has spent only half of its more than $1.4 billion in available federal money on what is called comparative effectiveness research and has largely ignored prescription drugs, despite their role in driving up health care costs, according to a study released Tuesday by a Washington-based research group.
The research into the comparative effectiveness of treatments and pharmaceuticals is meant to determine whether lower-cost options provide the same benefit as more expensive procedures and drugs.
The Patient-Centered Outcomes Research Institute (PCORI) has paid for a higher percentage of comparative effectiveness research in the past two years, from 37% in 2014 to 58% now, according to the new study by the Center for American Progress, a Democratic-leaning research group. Since PCORI’s creation in the 2010 Affordable Care Act, it has spent 51% on comparative effectiveness research, the study showed.
The institute hasn’t focused on what the Affordable Care Act intended, says Topher Spiro, CAP’s vice president of health policy and a former Democratic Senate health committee aide who worked on the law. The study was led by Ezekiel Emanuel, an oncologist and former White House health policy adviser who helped write the law.
Research gaps “involve highcost treatments, such as certain drugs, medical devices, and surgical procedures,” the report said. That’s in part because some experts say PCORI has been afraid to conduct research that could antagonize “powerful industries.”
For example, only 4% of the research compares two or more drugs, although drugs account for 17% of overall health care spending, the report said.
PCORI Executive Director Joe Selby, a physician, said he disagreed with how the report defined comparative effectiveness research (CER) as strictly head-tohead comparisons but acknowledged the institute had a “bit of a lull” in funding research at first. There weren’t nearly as many major drug introductions when PCORI started, he says.
PCORI has been criticized since it first appeared in 2009 in the legislation that became the ACA. Although CER had bipartisan support, the institute was caught in the politics surrounding what former Republican vice presiden- tial candidate Sarah Palin called “death panels” that could decide who received medical treatment.
Despite widespread concerns about rising drug costs, CER is attacked by patient groups supported by the pharmaceutical industry that claim the research could limit access to some lifesaving drugs.
Congress limited the ability of PCORI to consider costs when comparing health care, drugs or prioritizing research studies. The institute has a 21-person board appointed by the Government Accountability Office, Congress’ investigative arm. Drug and medical device makers have board positions along with a wide range of other experts, including Francis Collins, the director of the National Institutes of Health.
Since 2010, former representative Tony Coelho, D-Calif., has led the Partnership to Improve Patient Care, a critic of comparative effectiveness research. Its work is paid for in part by the pharmaceutical industry — though he won’t say how much — and other patient groups.
“I’m their big advocate and also a critic,” Coelho, who has epilepsy, said of PCORI in an interview.
Coelho said Sen. Ted Kennedy, D-Mass., asked him to chair the group because of his political background, his disability and because he wouldn’t let anyone “unduly influence” him in efforts to get patients’ voices heard.
Patient groups are major players in what PCORI decides to research. That can limit the focus on finding lower-cost options, which could hurt the profitability of the companies that fund the patient groups.
If PCORI paid for more headto-head research, it would be easy for insurers and other business to pay for the cost analyses, said institute board member Harlan Krumholz, a cardiologist.
“I would like to see us sprint towards doing as much comparative research as possible,” says Krumholz, also a Yale University professor and health care researcher. “We don’t need to look at cost; we need to look at effectiveness.”
Asked to single out the most significant research findings to date, Selby points to studies that found oral antibiotics can work as well as those delivered intravenously to children with serious bone infections.