Skip to main content
Erschienen in: PharmacoEconomics 10/2010

01.10.2010 | International Perspectives

Using Comparative Effectiveness Research to Inform Policy and Practice in the UK NHS

Past, Present and Future

verfasst von: Kalipso Chalkidou, MD, PhD, Tom Walley

Erschienen in: PharmacoEconomics | Ausgabe 10/2010

Einloggen, um Zugang zu erhalten

Abstract

Health systems that have fixed budgets and a coherent organizational structure generally have found it valuable to have a dedicated primary research capacity to answer decision-oriented value-for-money questions of particular importance to the system. The UK NHS is one example of such a system. Here, we review the historical evolution of building comparative effectiveness research (CER) capacity in the NHS, describe the current situation, with a focus on how this research is used to inform decisions, and discuss present and emerging challenges. We draw some possible lessons for the US, which is currently considering using CER to inform healthcare policy and practice decisions.
Fußnoten
1
There is evidence that NICE has reduced variation in uptake of innovative new drugs, such as cancer drugs, although variation still exists across the NHS.[27]
 
Literatur
1.
Zurück zum Zitat Tunis SR, Stryer DB, Clancy CM. Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy. JAMA 2003 Sep 24; 290 (12): 1624–32PubMedCrossRef Tunis SR, Stryer DB, Clancy CM. Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy. JAMA 2003 Sep 24; 290 (12): 1624–32PubMedCrossRef
2.
Zurück zum Zitat Chalkidou K, Tunis S, Lopert R, et al. Comparative effectiveness research and evidence-based health policy: experience from four countries. Milbank Q 2009 Jun; 87 (2): 339–67PubMedCrossRef Chalkidou K, Tunis S, Lopert R, et al. Comparative effectiveness research and evidence-based health policy: experience from four countries. Milbank Q 2009 Jun; 87 (2): 339–67PubMedCrossRef
3.
Zurück zum Zitat American Recovery and Reinvestment Act of 2009, HR1, 111th Cong. American Recovery and Reinvestment Act of 2009, HR1, 111th Cong.
4.
Zurück zum Zitat Patient Protection and Affordable Care Act of 2010, HR 3590, 111th Cong. Patient Protection and Affordable Care Act of 2010, HR 3590, 111th Cong.
6.
Zurück zum Zitat Ferner RE, McDowell SE. A model for NICE in the US. BMJ 2009 Jun; 338: b2221CrossRef Ferner RE, McDowell SE. A model for NICE in the US. BMJ 2009 Jun; 338: b2221CrossRef
7.
Zurück zum Zitat Dhruva SS, Phurrough SE, Salive ME, et al. CMS’s landmark decision on CT colonography: examining the relevant data. N Engl J Med 2009 Jun 25; 360 (26): 2699–701PubMedCrossRef Dhruva SS, Phurrough SE, Salive ME, et al. CMS’s landmark decision on CT colonography: examining the relevant data. N Engl J Med 2009 Jun 25; 360 (26): 2699–701PubMedCrossRef
8.
Zurück zum Zitat Culyer AJ. Supporting research and development in the National Health Service: a report to the Minister for Health by a research and development task force chaired by Professor Anthony Culyer. London: HMSO, 1994 Culyer AJ. Supporting research and development in the National Health Service: a report to the Minister for Health by a research and development task force chaired by Professor Anthony Culyer. London: HMSO, 1994
9.
Zurück zum Zitat Black N. A national strategy for research and development: lessons from England. Annu Rev Public Health 1997; 18: 485–505PubMedCrossRef Black N. A national strategy for research and development: lessons from England. Annu Rev Public Health 1997; 18: 485–505PubMedCrossRef
10.
Zurück zum Zitat Evans I, Thornton H, Chalmers I. Testing treatments: better research for better healthcare. London: The British Library, 2007 Evans I, Thornton H, Chalmers I. Testing treatments: better research for better healthcare. London: The British Library, 2007
11.
Zurück zum Zitat The House of Lords Select Committee on Science and Technology, Session 1987-88, 3rd Report. Priorities in Medical Research [HL 54-I, 54-II & 54-III] The House of Lords Select Committee on Science and Technology, Session 1987-88, 3rd Report. Priorities in Medical Research [HL 54-I, 54-II & 54-III]
12.
Zurück zum Zitat Department of Health. Research for health. London: HMSO, 1991 Department of Health. Research for health. London: HMSO, 1991
13.
Zurück zum Zitat McCollum C. UK National Health Service R&D funding: a bureaucratic nightmare [letter]. Lancet 2003 May 31; 361 (9372): 1906PubMedCrossRef McCollum C. UK National Health Service R&D funding: a bureaucratic nightmare [letter]. Lancet 2003 May 31; 361 (9372): 1906PubMedCrossRef
14.
Zurück zum Zitat McNally N, Kerrison S, Pollock AM. Reforming clinical research and development in England. BMJ 2003 Sep 6; 327 (7414): 550–3PubMedCrossRef McNally N, Kerrison S, Pollock AM. Reforming clinical research and development in England. BMJ 2003 Sep 6; 327 (7414): 550–3PubMedCrossRef
15.
Zurück zum Zitat Culyer AJ. Economics and public policy: NHS research and development as a public good. York: The University of York, 1998 Culyer AJ. Economics and public policy: NHS research and development as a public good. York: The University of York, 1998
18.
Zurück zum Zitat Horton R. Health research in the UK: the price of success. Lancet 2006 Jul 8; 368 (9530): 93–7PubMedCrossRef Horton R. Health research in the UK: the price of success. Lancet 2006 Jul 8; 368 (9530): 93–7PubMedCrossRef
19.
20.
Zurück zum Zitat Walley T. Health technology assessment in England: assessment and appraisal. Med J Aust 2007 Sep 3; 187 (5): 283–5PubMed Walley T. Health technology assessment in England: assessment and appraisal. Med J Aust 2007 Sep 3; 187 (5): 283–5PubMed
21.
Zurück zum Zitat Cooksey D. A review of UK health research funding. London: HM Treasury, 2006 Cooksey D. A review of UK health research funding. London: HM Treasury, 2006
25.
Zurück zum Zitat Chalmers I. Minimizing harm and maximizing benefit during innovation in health care: controlled or uncontrolled experimentation? Birth 1986 Sep; 13 (3): 155–64PubMedCrossRef Chalmers I. Minimizing harm and maximizing benefit during innovation in health care: controlled or uncontrolled experimentation? Birth 1986 Sep; 13 (3): 155–64PubMedCrossRef
26.
Zurück zum Zitat Chalmers I. Well informed uncertainties about the effects of treatments. BMJ 2004 Feb 28; 328 (7438): 475–6PubMedCrossRef Chalmers I. Well informed uncertainties about the effects of treatments. BMJ 2004 Feb 28; 328 (7438): 475–6PubMedCrossRef
28.
Zurück zum Zitat Department ofHealth. The new NHS. London: Department of Health, 1997 Department ofHealth. The new NHS. London: Department of Health, 1997
29.
Zurück zum Zitat Pearson SD, Rawlins MD. Quality, innovation, and value for money: NICE and the British National Health Service. JAMA 2005 Nov 23; 294 (20): 2618–22PubMedCrossRef Pearson SD, Rawlins MD. Quality, innovation, and value for money: NICE and the British National Health Service. JAMA 2005 Nov 23; 294 (20): 2618–22PubMedCrossRef
32.
Zurück zum Zitat Department of Health. Faster access to modern treatment: how NICE appraisal will work. London: Department of Health, 1999: paragraphs 33–36 Department of Health. Faster access to modern treatment: how NICE appraisal will work. London: Department of Health, 1999: paragraphs 33–36
33.
Zurück zum Zitat Chalkidou K, Hoy A, Littlejohns P. Making a decision to wait for more evidence: when the National Institute for Health and Clinical Excellence recommends a technology only in the context of research. J R Soc Med 2007 Oct; 100 (10): 453–60PubMedCrossRef Chalkidou K, Hoy A, Littlejohns P. Making a decision to wait for more evidence: when the National Institute for Health and Clinical Excellence recommends a technology only in the context of research. J R Soc Med 2007 Oct; 100 (10): 453–60PubMedCrossRef
34.
Zurück zum Zitat Tunis SR, Pearson SD. Coverage options for promising technologies: Medicare’s ‘coverage with evidence development’. Health Aff (Millwood) 2006 Sep-Oct; 25 (5): 1218–30CrossRef Tunis SR, Pearson SD. Coverage options for promising technologies: Medicare’s ‘coverage with evidence development’. Health Aff (Millwood) 2006 Sep-Oct; 25 (5): 1218–30CrossRef
35.
Zurück zum Zitat Chalmers I. Addressing uncertainties about the effects of treatments offered to NHS patients: whose responsibility? J R Soc Med 2007 Oct; 100 (10): 440–1PubMedCrossRef Chalmers I. Addressing uncertainties about the effects of treatments offered to NHS patients: whose responsibility? J R Soc Med 2007 Oct; 100 (10): 440–1PubMedCrossRef
36.
37.
Zurück zum Zitat Pearson SD, Miller FG, Emanuel EJ. Medicare’s requirement for research participation as a condition of coverage: is it ethical? JAMA 2006 Aug 23; 296 (8): 988–91PubMedCrossRef Pearson SD, Miller FG, Emanuel EJ. Medicare’s requirement for research participation as a condition of coverage: is it ethical? JAMA 2006 Aug 23; 296 (8): 988–91PubMedCrossRef
38.
Zurück zum Zitat Sudlow CL, Counsell CE. Problems with UK government’s risk sharing scheme for assessing drugs for multiple sclerosis. BMJ 2003 Feb 15; 326 (7385): 388–92PubMedCrossRef Sudlow CL, Counsell CE. Problems with UK government’s risk sharing scheme for assessing drugs for multiple sclerosis. BMJ 2003 Feb 15; 326 (7385): 388–92PubMedCrossRef
39.
Zurück zum Zitat Raftery J. Multiple sclerosis risk sharing scheme: a costly failure. BMJ 2010; 340: c1672 Raftery J. Multiple sclerosis risk sharing scheme: a costly failure. BMJ 2010; 340: c1672
41.
Zurück zum Zitat Sullivan FM, Swan IR, Donnan PT, et al. Early treatment with prednisolone or acyclovir in Bell’s palsy. N Engl J Med 2007; 357: 1598–607PubMedCrossRef Sullivan FM, Swan IR, Donnan PT, et al. Early treatment with prednisolone or acyclovir in Bell’s palsy. N Engl J Med 2007; 357: 1598–607PubMedCrossRef
42.
Zurück zum Zitat Gray A, Goodacre S, Newby DE, et al., 3CPO Trialists. Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med 2008; 359: 142–51 Gray A, Goodacre S, Newby DE, et al., 3CPO Trialists. Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med 2008; 359: 142–51
43.
Zurück zum Zitat UKEVAR Trial Investigators, Greenhalgh RM, Brown LC,et al. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 2010 May 20; 362 (20): 1863–71CrossRef UKEVAR Trial Investigators, Greenhalgh RM, Brown LC,et al. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 2010 May 20; 362 (20): 1863–71CrossRef
44.
Zurück zum Zitat Dumville JC, Worthy G, Bland JM, et al., VenUS II team. Larval therapy for leg ulcers (VenUS II): randomised controlled trial. BMJ 2009; 338: b773 Dumville JC, Worthy G, Bland JM, et al., VenUS II team. Larval therapy for leg ulcers (VenUS II): randomised controlled trial. BMJ 2009; 338: b773
45.
Zurück zum Zitat Peek GJ, Mugford M, Tiruvoipati R, et al., for the CESAR trial collaboration. Efficacy and economic assessment of conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009; 374: 1351–63 Peek GJ, Mugford M, Tiruvoipati R, et al., for the CESAR trial collaboration. Efficacy and economic assessment of conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009; 374: 1351–63
46.
Zurück zum Zitat Tyrer P, Oliver-Africano PC, Ahmed Z, et al. Risperidone, haloperidol, and placebo in the treatment of aggressive challenging behaviour in patients with intellectual disability: a randomised controlled trial. Lancet 2008; 371: 57–63PubMedCrossRef Tyrer P, Oliver-Africano PC, Ahmed Z, et al. Risperidone, haloperidol, and placebo in the treatment of aggressive challenging behaviour in patients with intellectual disability: a randomised controlled trial. Lancet 2008; 371: 57–63PubMedCrossRef
47.
Zurück zum Zitat CRASH-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. Epub 2010 Jun 14 CRASH-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. Epub 2010 Jun 14
49.
Zurück zum Zitat Department of Health. The 2009 Pharmaceutical Price Regulation Scheme. London: Department of Health, 2009 Department of Health. The 2009 Pharmaceutical Price Regulation Scheme. London: Department of Health, 2009
50.
Zurück zum Zitat Garber AM, McClellan MB. Satisfaction guaranteed: ‘payment by results’ for biologic agents. NEngl J Med 2007 Oct 18; 357 (16): 1575–7CrossRef Garber AM, McClellan MB. Satisfaction guaranteed: ‘payment by results’ for biologic agents. NEngl J Med 2007 Oct 18; 357 (16): 1575–7CrossRef
51.
Zurück zum Zitat Chalkidou K, Lord J, Fischer A, et al. Evidence-based decision making: when should we wait for more information? Health Aff (Millwood) 2008 Nov-Dec; 27 (6): 1642–53CrossRef Chalkidou K, Lord J, Fischer A, et al. Evidence-based decision making: when should we wait for more information? Health Aff (Millwood) 2008 Nov-Dec; 27 (6): 1642–53CrossRef
53.
Zurück zum Zitat National Eye Institute (NEI). Comparison of age-related macular degeneration treatments trials: Lucentis-Avastin trial [ClinicalTrials.gov identifier NCT00593450]. US National Institutes of Health, ClinicalTrials.gov [online]. Available from URL: http://clinicaltrials.gov [Accessed 2010 Jun 17] National Eye Institute (NEI). Comparison of age-related macular degeneration treatments trials: Lucentis-Avastin trial [ClinicalTrials.gov identifier NCT00593450]. US National Institutes of Health, ClinicalTrials.gov [online]. Available from URL: http://​clinicaltrials.​gov [Accessed 2010 Jun 17]
56.
Zurück zum Zitat Appleby J, Philips M. The NHS: satisfied now? In: Park A, Curtice J, Thomson K, et al., editors. British social attitudes, 25th report. London: Sage Publications Ltd, 2009: 25–51CrossRef Appleby J, Philips M. The NHS: satisfied now? In: Park A, Curtice J, Thomson K, et al., editors. British social attitudes, 25th report. London: Sage Publications Ltd, 2009: 25–51CrossRef
57.
Zurück zum Zitat Samuelson P. The pure theory of public expenditure. Rev Econ Stat 1954; 36 (4): 387–9CrossRef Samuelson P. The pure theory of public expenditure. Rev Econ Stat 1954; 36 (4): 387–9CrossRef
58.
Zurück zum Zitat Reinhardt UE. An information infrastructure for the pharmaceutical market. Health Aff (Millwood) 2004 Jan-Feb; 23 (1): 107–12CrossRef Reinhardt UE. An information infrastructure for the pharmaceutical market. Health Aff (Millwood) 2004 Jan-Feb; 23 (1): 107–12CrossRef
59.
Zurück zum Zitat Longo WE, Cheadle W, Fink A, et al. The role of the Veterans Affairs Medical Centers in patient care, surgical education, research and faculty development. Am J Surg 2005 Nov; 190 (5): 662–75PubMedCrossRef Longo WE, Cheadle W, Fink A, et al. The role of the Veterans Affairs Medical Centers in patient care, surgical education, research and faculty development. Am J Surg 2005 Nov; 190 (5): 662–75PubMedCrossRef
65.
Zurück zum Zitat Wishart A. The price of life [television programme]. London: BBC, 2009 Wishart A. The price of life [television programme]. London: BBC, 2009
68.
Zurück zum Zitat Porter ME, Teisberg EO. Redefining competition in health care. Harv Bus Rev 2004 Jun; 82 (6): 64–76, 136PubMed Porter ME, Teisberg EO. Redefining competition in health care. Harv Bus Rev 2004 Jun; 82 (6): 64–76, 136PubMed
Metadaten
Titel
Using Comparative Effectiveness Research to Inform Policy and Practice in the UK NHS
Past, Present and Future
verfasst von
Kalipso Chalkidou, MD, PhD
Tom Walley
Publikationsdatum
01.10.2010
Verlag
Springer International Publishing
Erschienen in
PharmacoEconomics / Ausgabe 10/2010
Print ISSN: 1170-7690
Elektronische ISSN: 1179-2027
DOI
https://doi.org/10.2165/11535260-000000000-00000

Weitere Artikel der Ausgabe 10/2010

PharmacoEconomics 10/2010 Zur Ausgabe