A leading health official has surprised legislators by suggesting that money from the US economic stimulus package could be used to fund studies comparing the cost-effectiveness of medical treatments.

The American Recovery and Reinvestment Act (ARRA) includes appropriations totaling $1.1 billion for comparative effectiveness studies, of which the National Institutes of Health (NIH) has been allocated $400 million. However, the NIH’s acting director, Raynard Kington, has told Congress that it might use funds from the total $10.4 billion it has received from ARRA, and not the $400 million set aside for the purpose, to finance “high-quality applications” which include cost comparisons.

This decision “would depend upon the ultimate decisions about the definition that will apply to that pool of funds,” Dr Kingston told a House Committee on Appropriations subcommittee hearing.

His comments have caused widespread surprise, and “could cause controversy among conservative lawmakers because of their stance that the $1.1 billion in comparative effectiveness research allotted by the stimulus should not go to compare the costs of treatment. They argue that the findings will be used to deny access to treatments found to be less cost-effective, thereby rationing health care,” comments the journal Congressional Quarterly (CQ).

CQ HealthBeat also points out that the Obama Administration has said that while comparative effectiveness studies which include cost comparisons could be funded out of the NIH’s $400 million, the federal Medicare health insurance programme would be barred from basing coverage decisions on the findings of such studies.

Meantime, the NIH has now published its list of “highest priority challenge topics” for which it is soliciting grant applications. Part of the agency’s largest-ever request for applications - a 220-page document listing topics in 15 broad scientific areas - it is calling, controversially, for studies into both the clinical and cost-effectiveness of: biologic drugs in autoimmune rheumatic and skin diseases; - treatments for chronic childhood arthritis and musculoskeletal and skin disease; and - reducing cardiovascular risk in moderate-risk and asymptomatic patients.

The list's 68 comparative effectiveness topics also cover antiretroviral and recently-approved fibromyalgia therapies, and treatments for: cancer, newly-discovered type 2 diabetes, age-related macular degeneration and diabetic eye disease and disorders, paediatric eye diseases and disorders and mild persistent asthma in children. In addition, it seeks comparisons of decision tools' ability, in an electronic health care system, to increase the use of generic drugs.

A full list of topics involved in the call for grant applications is available at: www.grants.nih.gov.

NIH is “determine to seize the opportunity afforded us by the infusion of ARRA resources to develop a nimble approach to investing the money quickly with the greatest impact - this opportunity is too important for us to conduct business as usual,” Dr Kington told the panel. He added that, in keeping with the ARRA reporting requirements, it is asking recipients to document key economic benefits, such as jobs created and retained. It is estimated that each NIH grant supports, on average, six or seven part- or full-time scientific jobs.

- Another $400 million of the total $1.1 billion provided by ARRA for comparative effectiveness research goes to the Office of the Secretary of Health and Human Services (HHS) and $300 million to the Agency for Healthcare Research and Quality (AHRQ)’s existing Effective Health Care programme. The Institute of Medicine (IOM) will issue a report on research priorities for these funds by June 30. Moreover, the 15 members of the ARRA-mandated Federal Coordinating Council for Comparative Effectiveness Research have now been named, and they will hold a public hearing on April 14.