Full article reprinted from "The Gray Sheet"- February 8, 2009
Funding comparative effectiveness research remains a priority of the administration, as evidenced by the $286 million earmarked in the president's fiscal year 2011 budget to "advancing patient-centered health research" at the Agency for Healthcare Research and Quality. Read more...
Comparative Effectiveness Gets Nod In Federal Budget Request
Full article reprinted from "The Gray Sheet"- February 8, 2009
Funding comparative effectiveness research remains a priority of the administration, as evidenced by the $286 million earmarked in the president's fiscal year 2011 budget to "advancing patient-centered health research" at the Agency for Healthcare Research and Quality.
The 2011 budget, released Feb. 1, would fund 138 research grants in AHRQ's Effective Health Care Program, which oversees the agency's comparative effectiveness activities. Of those, 105 would be new for 2011.
The $286 million represents a whopping $261 million increase from fiscal 2010 funding of AHRQ's comparative effectiveness budget, but it is primarily intended to keep up with the massive investment in the head-to-head research efforts from the 2009 economic stimulus package.
The American Recovery and Reinvestment Act included a total of $1.1 billion to fund comparative effectiveness efforts in 2009 and 2010, including $300 million to AHRQ, $400 million to the National Institutes of Health and $400 million at the discretion of the Health and Human Service secretary.
More than half of that money still remains to be spent (The Gray Sheet' Aug. 10, 2009). For instance, just last week, AHRQ announced that it plans use ARRA funds to award a contract to establish a Horizon Scanning System.
The new system would identify and monitor new technologies, refine and implement methodology to forecast the future clinical and cost impact of those technologies, and review horizon scanning methods used by other organizations in and outside the U.S.
In addition to directly funding studies, the 2011 requested comparative effectiveness money would also support projects like the one intended to improve the overall infrastructure for collecting useful data.
Industry Awaits
As always with comparative effectiveness proposals, device industry reps are anxious to see the details on who will be involved in deciding research priorities, what data will be collected and how it will be used.
The debate over the stimulus package funding centered on those issues, and in particular concerns by manufacturers and others that the government would collect cost-effectiveness, as well as clinical effectiveness data, and use it to restrict coverage for newer, but expensive technologies.
Despite some language in the report accompanying the ARRA legislation intended to assuage these worries, several NIH projects employing the legislation's comparative effectiveness funds do explicitly involved cost comparisons(The Gray Sheet' Jan. 11, 2010).
The long-term process and infrastructure for applying comparative effectiveness data was intended to be established by health care reform legislation. But with passage of such a bill in serious doubt, at least in the short term, such clarity remains elusive.
"We'd like to see what's going to happen legislatively, if anything," said Tom Novelli, director of federal affairs for the Medical Device Manufacturers Association
MDMA members remain concerned about the cost-effectiveness issue, he said, as well as ensuring that the iterative design model for devices is recognized by policy makers.
David Nexon, AdvaMed's senior executive vice president, stressed the need for transparency and stakeholder involvement.
Total AHRQ Budget
The total budget request for AHRQ in fiscal 2011 is $611 million, a $214 increase from 2010 funding. By far the biggest increase goes to comparative effectiveness, with more modest increases targeted at health care IT and other programs.
AHRQ would actually see a $26 million reduction in general patient safety research funding due to discontinuation of a demonstration project in medical liability reform. The agency would spend under the budget $34 million in 2011 to reduce and prevent healthcare-associated infections.
- Monica Hogan
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