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The Pragmatist’s Guide to Comparative Effectiveness Research

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  • Amitabh Chandra
  • Anupam B. Jena
  • Jonathan S. Skinner

Abstract

All developed countries have been struggling with a trend toward health care absorbing an ever-larger fraction of government and private budgets. Adopting any treatment that improves health outcomes, no matter what the cost, can worsen allocative inefficiency by paying dearly for small health gains. One potential solution is to rely more heavily on studies of the costs and effectiveness of new technologies in an effort to ensure that new spending is justified by a commensurate gain in consumer benefits. But not everyone is a fan of such studies and we discuss the merits of comparative effectiveness studies and its cousin, cost-effectiveness analysis. We argue that effectiveness research can generate some moderating effects on cost growth in healthcare if such research can be used to nudge patients away from less-effective therapies, whether through improved decision making or by encouraging beefed-up copayments for cost-ineffective procedures. More promising still for reducing growth is the use of a cost-effectiveness framework to better understand where the real savings lie—and the real savings may well lie in figuring out the complex interaction and fragmentation of healthcare systems.

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Bibliographic Info

Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 16990.

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Date of creation: Apr 2011
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Publication status: published as Amitabh Chandra & Anupam B. Jena & Jonathan S. Skinner, 2011. "The Pragmatist's Guide to Comparative Effectiveness Research," Journal of Economic Perspectives, American Economic Association, vol. 25(2), pages 27-46, Spring.
Handle: RePEc:nbr:nberwo:16990

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  1. Garber, Alan M. & Phelps, Charles E., 1997. "Economic foundations of cost-effectiveness analysis," Journal of Health Economics, Elsevier, Elsevier, vol. 16(1), pages 1-31, February.
  2. Douglas Almond & Joseph J. Doyle, Jr. & Amanda E. Kowalski & Heidi Williams, 2008. "Estimating Marginal Returns to Medical Care: Evidence from At-Risk Newborns," NBER Working Papers 14522, National Bureau of Economic Research, Inc.
  3. Nord, Erik & Richardson, Jeff & Street, Andrew & Kuhse, Helga & Singer, Peter, 1995. "Who cares about cost? Does economic analysis impose or reflect social values?," Health Policy, Elsevier, Elsevier, vol. 34(2), pages 79-94, November.
  4. DiMasi, Joseph A. & Hansen, Ronald W. & Grabowski, Henry G., 2003. "The price of innovation: new estimates of drug development costs," Journal of Health Economics, Elsevier, Elsevier, vol. 22(2), pages 151-185, March.
  5. Meltzer, David, 1997. "Accounting for future costs in medical cost-effectiveness analysis," Journal of Health Economics, Elsevier, Elsevier, vol. 16(1), pages 33-64, February.
  6. Anirban Basu & Tomas J. Philipson, 2010. "The Impact of Comparative Effectiveness Research on Health and Health Care Spending," NBER Working Papers 15633, National Bureau of Economic Research, Inc.
  7. Anupam Jena & Tomas Philipson, 2009. "Endogenous Cost-Effectiveness Analysis in Health Care Technology Adoption," NBER Working Papers 15032, National Bureau of Economic Research, Inc.
  8. Katherine Baicker & Jonathan S. Skinner, 2011. "Health Care Spending Growth and the Future of U.S. Tax Rates," NBER Working Papers 16772, National Bureau of Economic Research, Inc.
  9. David Meltzer, 1997. "Accounting for Future Costs in Medical Cost-Effectiveness Analysis," NBER Working Papers 5946, National Bureau of Economic Research, Inc.
  10. Amitabh Chandra & Douglas O. Staiger, 2007. "Productivity Spillovers in Health Care: Evidence from the Treatment of Heart Attacks," Journal of Political Economy, University of Chicago Press, University of Chicago Press, vol. 115, pages 103-140.
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Cited by:
  1. Liran Einav & Amy Finkelstein & Heidi Williams, 2014. "Paying on the margin for medical care: Evidence from breast cancer treatments," Discussion Papers, Stanford Institute for Economic Policy Research 13-034, Stanford Institute for Economic Policy Research.
  2. David H. Howard & Yu-Chu Shen, 2011. "Comparative Effectiveness Research, COURAGE, and Technological Abandonment," NBER Working Papers 17371, National Bureau of Economic Research, Inc.
  3. Ian M. McCarthy, 2014. "Treatment Effects on Combined Outcomes: An Application to Health-related Quality-of-life Data," Emory Economics, Department of Economics, Emory University (Atlanta) 1409, Department of Economics, Emory University (Atlanta).
  4. Amitabh Chandra & Jonathan Skinner, 2012. "Technology Growth and Expenditure Growth in Health Care," Journal of Economic Literature, American Economic Association, vol. 50(3), pages 645-80, September.
  5. repec:exc:wpaper:2013-09 is not listed on IDEAS

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