Improving Value

Comparative Effectiveness Research

Comparative effectiveness research (CER) answers questions about how well alternative medical treatments work.1 CER can take many forms, such as: systematic reviews of the literature; creation of large research databases, including electronic health records; prospective registries and cohort studies and randomized controlled trials.  

Surprisingly, the Institute of Medicine estimates that more than half of the treatments delivered today are without clear evidence of effectiveness.2 Similarly, Clinical Evidence, a project of the British Medical Journal, combed through the 3,000 medical treatments that have been studied in controlled, randomized studies. They found, for half of those, we have no idea how well they work.3 This treatment uncertainty contributes to great variability in managing clinical problems, with costs and outcomes differing markedly across the country.

Undertaking comparative effectiveness research alone does not necessarily save money; the savings depend on whether the research impacts practice patterns and insurers' coverage decisions.  What’s more, tying CER back to how we pay, also known as cost-effectiveness research, is politically controversial. Cost-effectiveness was largely excluded from the comparative effectiveness research effort funded by the Affordable Care Act.  

Despite the language in the Affordable Care Act that restricts the use of cost-effectiveness analysis, backers of comparative effectiveness research say it could lead to making better use of the nation's healthcare dollars. If there's more clarity about which treatments work best—and for which types of patients—there's potential for shifting money to those interventions and away from less effective treatments.  


1. Comparative Effectiveness Research, Health Affairs, Health Policy Brief (Oct. 8, 2010).

2. Institutes of MedicineLearning What Works: Infrastructure Required for Comparative Effectiveness Research: Workshop Summary (2007).

3. "Surprise! We don’t know if half our medical treatments work," Washington Post (Jan. 24, 2013).