Costs must be considered in comparative effectiveness studies of drugs and other medical treatments, a scientific advisory panel has told the US Congress.

When comparing the effectiveness of treatments, "the overall value of a strategy can be understood best by considering costs and benefits together," says the Institute of Medicine (IoM), in a report published yesterday which recommends 100 health topics which the Institute says should receive priority attention and funding from the US government's new $1.1 billion comparative effectiveness research (CER) initiative.

"Health care decisions too often are a matter of guesswork because we lack good evidence to inform them," said Harold Sox, editor of the Annals of Internal Medicine, who co-chaired the panel convened by the IoM to develop the list of priority topics.

The panel’s recommendations were “informed by extensive public input,” it says, with 1,278 unique research topics being suggested by professional groups, legislators and the public. However, the industry’s response was ”muted,” said Dr Sox, with only 11 suggestions coming from pharmaceutical and biotechnology firms, and 17 from device makers.

While stating that consideration of treatment costs needs to be part of the process, the report does not include it in assessing the CER initiative’s priorities, because this is “a very big topic” and the panel knew they did not have sufficient time to deal with it, added Dr Sox.

The report calls for prioritization of CER topics to be “a sustained and continuous process, recognizing the dynamic state of disease, interventions, and public concern.” Public participation in the priority-setting process is essential, and the programme’s findings should be adopted rapidly, it adds.

The study, which was sponsored by the Department of Health Human services, was undertaken at the request of Congress to advise on how the $400 million allocated to the Department for CER research should be spent, but the panel suggests that its list “could be useful” beyond that by influencing the distribution of funds by the National Institutes of Health and other agencies which fund CER.

“CER must be an ongoing process,” it emphasises. “Health care is dynamic; new diseases and health needs can arise suddenly and other health problems might become insignificant when a treatment is found. As new CER produces new evidence and closes gaps in evidence, CER might need to take new directions.”

- To read the IoM’s list of 100 priority topics for CER, visit: