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Letters |6 January 2009

How Can Cost-Effectiveness Information Help Control Unsustainable Growth in U.S. Health Care Spending?

Neil M. Kirschner, PhD; Stephen G. Pauker, MD; Joseph W. Stubbs, MD

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Author, Article, and Disclosure Information
Potential Financial Conflicts of Interest: None disclosed.
  • From the American College of Physicians, Philadelphia, PA 19106; Tufts Medical Center, Boston, MA 02111; and Albany, GA 31707.
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Potential Financial Conflicts of Interest: None disclosed.
TO THE EDITOR:
Garber (1) and Wilensky (2) both recognize the importance of information about comparative effectiveness and cost in making rational choices among alternative therapies. Extending Garber's analogy, without information about comparative effectiveness and cost-effectiveness, we are ordering not only from a menu without prices but also, for many, from a menu written in a foreign language. Both components from a trusted source are needed to make rational, effective health care decisions.
Although we recognize Wilensky's superb knowledge of political realities, we disagree strongly with her call for a separate entity (that is, the payers) to develop unbiased data on cost-effectiveness. Studies of comparative effectiveness and cost-effectiveness are commonly done together (as in the United Kingdom's National Institute for Health and Clinical Excellence program), whether within a clinical trial or in analyses of data from combinations of trials. Requiring investigators to seek funding from 2 different entities would impede progress. Furthermore, leaving cost-effectiveness analyses to the payers, as Wilensky suggests, also would bring into question the trustworthiness of the results. Payers have their own interests and perspectives and do not always provide unbiased, transparent analyses.
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Kirschner NM, Pauker SG, Stubbs JW. How Can Cost-Effectiveness Information Help Control Unsustainable Growth in U.S. Health Care Spending?. Ann Intern Med. ;150:57. doi: 10.7326/0003-4819-150-1-200901060-00013

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Published: Ann Intern Med. 2009;150(1):57.

DOI: 10.7326/0003-4819-150-1-200901060-00013

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