Obama's budget would boost funds for health research

Kaiser Health NewsFebruary 2, 2010 

WASHINGTON — The Obama administration, in an effort to forge ahead with its controversial effort to compare various medical treatments, is proposing a big boost in funding for the agency that oversees the research.

Proponents say that the research can provide patients and their doctors with crucial information to help them decide among various drugs or treatments. Critics say the research could be used to limit or ration care if the federal government or insurers used the information to deny coverage for a particular test or procedure because it was found to be less effective.

The administration's 2011 budget proposes to spend $286 million on comparative-effectiveness research overseen by the federal Agency for Healthcare Research and Quality. The agency got $21 million for such research in its current fiscal-year budget, and an additional $300 million for the research in the economic stimulus bill.

Efforts to compare drugs or treatments aren't new; private insurers and Medicare consider medical evidence at times in bids to determine whether new treatments work well for particular types of patients. The research is often controversial, however.

In December, for example, a recommendation from a government task force about annual mammograms for women younger than 50 raised concerns among advocacy groups and lawmakers that it might lead to restrictions on mammograms for some women.

In the fiscal 2011 budget proposal for the Department of Health and Human Services, officials used the term "patient-centered health research" rather than "comparative effectiveness," a shift that some analysts said was done to distance the issue from its somewhat painful past on Capitol Hill.

The House of Representatives and Senate health care-overhaul bills — now stalled in Congress — also would boost funding for comparative-effectiveness research.

The House legislation would provide $300 million over three years, according to an analysis from Avalere Health, a Washington-based consulting firm. The Senate proposed creating a nonprofit, nongovernmental agency to oversee the research effort, spending $165 million over three years, according to the analysis.

In an interview, the director of the Agency for Healthcare Research and Quality, Carolyn Clancy, said that if Congress approved the president's request, the funding would be used to continue the agency's research in 14 areas, including cancer, obesity and substance abuse.

"We're going to continue the work we're doing now to, frankly, fill the huge gaps in information that clinicians and patients face every day," Clancy said. "It's almost a byproduct of how well we've done in biomedical science that for many, many decisions, diagnosis and treatment, patients and clinicians have two or more options. What they don't have is good, comparative information that helps them figure out that for this individual what's the right choice to make."

Tony Coelho, the chairman of the Partnership to Improve Patient Care, a group that opposes using comparative-effectiveness research for insurance-coverage decisions, said that patients and physicians must be involved in any federal efforts in such research and that Congress should closely track how the money is spent.

"As this provision goes forward I would think a lot of members in the House and the Senate would want to know a little bit more about what the administration has in mind and how they want to spend this additional money, as opposed to what they're doing with the money they already have," Coelho said.

Mark McClellan, a former administrator of the Centers for Medicare and Medicaid Services, said that while many health care groups supported the intent of comparative-effectiveness research, "the next round of the debate is whether there is a way for Congress to comfortably support developing better evidence to guide individuals' decisions without raising this fear of controlling those decisions. . . . Whichever side of the debate you're on, we need better evidence."

McClellan directs the Engelberg Center for Health Care Reform at the Brookings Institution, a center-left policy research center in Washington.

(Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy-research organization that isn't affiliated with Kaiser Permanente.)

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