Comparative effectiveness comes to the US

This article has reached fairly high on the NY Times most emailed...

U.S., as Part of Stimulus Bill, Will Compare Effectiveness of Medical Treatments - NYTimes.com

I'm actually surprised that this got put into the stimulus bill. A welcome addition, for those of us thinking and working on the issue. But of course, devil is in the details.

I am here in London, and talking to folks about this development and parallels to NICE, it's interesting to hear the UK perspective. NICE (National Institute for Health and Clinical Excellence) publishes clinical appraisals of whether particular treatments should be considered worthwhile by the NHS. These appraisals are based primarily on cost-effectiveness as measured by QALYs. Anecdotal, but I am told that ~75% of NICE's recommendations are around clinical pathways, not pharmaceutical approval. And NICE is primarily an advisory body, and must rely on NHS Primary Care Trusts (essentially the UK payor) to enforce the clinical pathways. But PCTs are hesitant to employ the pathways, because they worry about disturbing their relationship with the providers.

Can easily see the same scenario playing out in the US - advisory body, little to no regulatory power - but the difference is that Obama's comparative effectiveness panel will advise CMS, not small payers like the UK's NHS PCTs (there are some 100+ PCTs for a ~75 million population! (that's very decentralized, if you're wondering)). For better or for worse, CMS has a bully pullpit from which to make major changes to the way health care is practiced in the US. I am eagerly awaiting the details...