The US Senate approved its $838 billion version of the American Recovery and Reinvestment Act on February 10 and negotiations are now underway to reconcile it with the $820 billion House version. One contentious issue will be the two bills’ proposals for comparative effectiveness research into medicines, as the House version would take a treatment’s cost into account, while the Senate’s would not.

President Barack Obama, who backed comparative effectiveness research during his election campaign, has called for the reconciled stimulus package to be on his desk by February 16.

Both bills contain $1.1 billion in funding for comparative effectiveness research for the National Institutes of Health (NIH), Agency for Healthcare Research and Quality (AHRQ) and other federal agencies. plus the establishment of a Federal Coordinating Council for Comparative Effectiveness Research. “Finding out what works best and educating patients and doctors will improve health care quality,” said Senator Edward Kennedy, chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee, welcoming the Senate vote on Tuesday.

Not only does the Senate version, which lists the initiative as Healthcare Research and Quality, take no account of a medical product’s costs, but it also adds the industry-approved word “clinical” to how the research is described.

When conducted appropriately, high-quality comparative clinical effectiveness research (CER) can be a useful tool for improving patient outcomes and medical decision-making, said Ken Johnson, senior vice president at the Pharmaceutical Research and Manufacturers of America (PhRMA).

The industry group has been working with Congress "in a constructive, bipartisan way” to ensure that the $1.1 billion CER funding would provide information to help patients and providers make good decisions about which medical options are best for the individual, “without shifting those decisions to a centralized government agency,” he said.

The Partnership to Improve Patient Care (PIPC), an industry and patient advocacy lobby group, also stresses that the stimulus bill’s comparative clinical effectiveness research provisions “must focus on clinical outcomes not cost-effectiveness, require full transparency and communication of study results, not policy decision-making.”

CER study results must not be misused to impose blunt, “one-size-fits-all” access restrictions, adds PIPC.

Other health care provisions

Meantime, both House and Senate versions of the economic stimulus bill would provide $87 billion to assist states with Medicaid, the means-tested health care programme for disabled people and those on low incomes which is funded jointly by the states and the federal government and run by the states. The House version provides $40 billion, and the Senate bill $20 billion, to subsidise health care insurance for the unemployed under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) programme, which allows workers who have been laid off to keep their employer’s health insurance for a certain period of time.

The Senate bill contains $22 billion – and the House version $20 billion - to modernize health information technology (IT) systems, and the Senators also backed $10 billion for health research and construction of NIH facilities.

Anne Gershon, president of the Infectious Diseases Society of America (IDSA), said she was “surprised and disappointed,” that proposals for a $5.8 billion Prevention and Wellness Fund, which would have invested in immunizations, health promotion, HIV/AIDS prevention and other programmes, were stripped out of the final version of the Senate bill. Such investments would have averted much larger health expenditures later, she said, and welcomed the House version’s proposal for $3 billion public health funding, calling for it to be included in the final reconciled package.

The approved Senate package also removed $870 million proposed funding for pandemic flu preparedness, while the House bill retains $900 million for this purpose.

- The Senate bill passed on a 61-37 vote, broadly along party lines, with support from just three Republicans and one independent.