Thursday, September 16, 2010

Might comparative effectiveness research lead to more expensive care?

This is purely tongue in cheek. I say tongue in cheek because it's based on this newspaper article which provides insufficient substance or background to really understand the research findings, and I haven't been able to find the primary source or a more reliable source. It purports that new comparative effectiveness research proves CABG to be superior to stenting in terms of mortality and major events. But it's sloppy. This statement was a red flag:

The new study, reported Sunday at a Geneva meeting of the European Association for Cardio-Thoracic Surgery, is the first large trial to compare stenting and coronary-artery bypass grafts directly.

No it's not! Sloppy, sloppy, sloppy.

That's why this is tongue in cheek, but suppose, for the sake of discussion, that it's true. If so it's an example of CER validating more expensive care, which leads Wesley Smith to ask:

This raises an interesting question. Bypass surgery is much more expensive than putting in stents. Would the Obamacare cost/benefit panels strongly recommend to cardiologists that they perform more bypass surgeries based on the evidence that it saves more lives, even though the cost is exponentially higher? To be consistent, they should. But I doubt they would.

The popular belief is that CER will lead to better and cheaper care. Is cheaper really better, or even as good? Sometimes it is, sometimes it isn't. In the aggregate, nobody knows. But the Obamacare policy wonks have an agenda to leverage CER, and the interpretation of CER's findings, for cheaper care, so Smith has a point here.

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