CER Definitions
In their recent interviews about what impact trials like the CATT study could have on policies and innovation, experts from around the globe shared their definitions of CER.
Louis Jacques, MD
"I would define it as a paradigm for a member of a defined population, with a particular outcome in mind. That research is being used to identify management strategies that would be more or less likely to be successful in that population. And while some people essentially explicitly consider cost in that, cost does not have to be necessarily included in a comparative or comparative effectiveness research paradigm."
David O. Meltzer, MD, PhD
"CER is research that compares alternatives, and those alternatives can be viewed through a variety of perspectives. One perspective is the patient’s perspective. It’s the easiest to understand from the standpoint of a single patient – “What’s best for me?” But, often we have to make decisions that affect many groups of patients. Or we have to make decisions for individuals that are based on information that isn’t ideally personalized for them, but puts them within a class of people that are like them. That can often make it difficult to define that patient perspective. But that’s just the start, CER can be considered in terms of policies that effect populations of people. It can be considered in terms of decision by healthcare systems and providers who may have complicated objective functions who certainly include patients, but may include providers and cost, or even profits. Also, from a societal perspective there are costs and benefits to many, many parties as a result of medical decisions, and good social policy requires thinking about those. To me those all include the benefits of treatments, as well as their cost.”
Kalipso Chalkidou, MD, PhD
“Comparative effectiveness research is basically a means of informing decisions based on evidence...It’s about informing consumers, and informing those that pay for care and those that offer care, about what the most appropriate treatment pathway is given their individual circumstances...Right now, the alternative to CER is basically having very little or no information. Comparative effectiveness can offer valuable information on what works and for whom."Kevin Frick, PhD, MA
“Comparative effectiveness research is a relatively new buzz word. It has some important distinctions from earlier ways of making comparisons between alternative treatments. First and foremost, and probably the biggest one, is that we’re always aiming to compare multiple, viable treatment options; rather than comparing something with a placebo, or comparing something with nothing—unless nothing is a treatment option that’s really viable—we always want compare two viable options. And we also want to compare them in as close to a real-world setting as possible. We want to dig down and figure out what does it do for specific sub-populations if that’s possible...So all of those things are important to consider. And one thing that’s not included in say the U.S. Federal Government definitions of comparative effectiveness, but I think goes hand-in-hand with comparative effectiveness, is also looking at cost in order to say what kind of value are we getting for what we are spending, and not just comparing two different treatments against each other.”Chris Henshall, PhD
“I think the most important thing about comparative effectiveness research, or relative effectiveness research as we tend to call it in Europe, is that it’s looking at effectiveness in the real world, in the setting in which treatments are actually given, and trying to compare effectiveness between real treatment options."William W. Li, MD
“I actually think that the Institute of Medicine has given one of the best definitions for CER, or Comparative Effectiveness Research, and their definition is quite effective. And that definition is that CER is the generation and synthesis of evidence that compares benefits and harms of alternative medicine to prevent, diagnose, treat, and monitor diseases or to improve the delivery of care. And according to the Institute of Medicine, CER’s stated purpose is to assist consumers, clinicians, purchasers, and policymakers to make informed decisions that will improve healthcare both on the individual level, as well as the population level. In other words, CER is an approach to health research that helps us compare different methods for treating the same disease.”Maureen G. Maguire, PhD
“I would define CER as comparison of two or more approaches to treatment in broad populations under very general conditions. A little bit differently than the typical clinical trial used to establish efficacy of treatment.”Barbara McLaughlan
"I think the definition is in some ways quite straight forward because it is comparative effectiveness research—so it really does what it says…which means that it’s supposed to provide robust evidence to allow clinicians and patients to choose between treatments. But obviously, there’s also a major issue in that it also gives an evidence base to payers to decide on the effective use of their limited resources."Dan Ollendorf, MPH, ARM
“I believe that CER in its best light should be considered an aid to decision-making. Because while it involves at times some sophisticated methodology to try to synthesize the available evidence, at its heart, what it attempts to do is to summarize that evidence in a way that will make cognitive comparisons of disparate interventions for a given condition feasible.”Alexander Ommaya, DSc, MA
“I think that the Institute of Medicine definition which was put out in their report last year is sort-of straightforward and gets to the point, which is that evidence that compares the benefits and harms of alternative methods to prevent, diagnose, and treat, and monitor clinical condition or to improve the delivery of care, describes what comparative effectiveness research is trying to do pretty well.”Sean Tunis, MD, MSc
“I think of CER as a way of looking at clinical and health services research that is more heavily weighted to addressing questions of patients, clinicians, and payers. So, my view is that traditionally researchers are somewhat informed about and conscious of what are the critical gaps and knowledge from the perspective of what decision-makers actually deal with…[T]he view is that if decisions makers were more involved upfront in deciding which questions to answer and the method by which those questions would be answered, there would be fewer gaps in knowledge and so a better body of evidence-informed decisions. It so happens that the kinds of questions that decision makers are the most interested in are often comparative questions, i.e. what are the plausible alternative ways of treating or diagnosing a condition. That’s why you frequently will see them as comparative questions. And the effectiveness piece refers to studies that are done in the real-world settings that are likely to be relevant to what people actually encounter in their own clinical situations and policy situations.”Cynthia Bens
"I consider CER to be research that compares the effectiveness of two or more types of interventions to determine which provides better care outcomes for certain patients. These interventions can be pharmacologic, non-pharmacologic, or interventions that improve systems of care. I also like to include elements of the Patient Centered Outcomes Research Institute’s definition of PCOR into the way I view CER. I think one of the most important elements of the PCOR definition is the recognition of the need 'to incorporate a wide variety settings and a diversity of participants in research to address individual differences.' This is a critical point that will allow us to focus on groups of patients who have historically been left out in research for various reasons. Ultimately I think the PCOR definition allows patients to really play an active role in defining research that will help achieve health outcomes that are important to them."