In a time of skyrocketing health care costs, both the private and public sectors struggle to balance economics with access to high quality health care. Evidence from comparative effectiveness research (CER) and “head-to-head” clinical trials is increasingly being used in health care treatment decision-making around the globe, but how will this affect access to quality care? More importantly, where will the public draw the line between cost and access?

The Alliance for Aging Research recently hosted a webcast examining the results of a 4-country public opinion survey conducted in partnership with the Harvard School of Public Health exploring public views in the United States, the United Kingdom, Italy and Germany on the use of comparative effectiveness research, its promise and its limitations. Moderated by Alliance President & CEO Dan Perry, the discussion also included Dr. Joe Selby, executive director of the independent, not-for-profit Patient-Centered Outcomes Research Institute (PCORI) , and Dr. Robert Blendon, project director of the survey, of the Harvard School of Public Health.

The results of the survey (the first of its kind to pose such issues to the general public) lay clear ‘guide rails’ that outline the public’s beliefs as to how CER should be used –namely that, in all four countries, the public supports access to the most effective treatments, regardless of cost, if there is independent evidence that demonstrates their efficacy. The public would accept a less-costly treatment option only if it were found to be as effective as the more expensive agent. In addition, the public does not agree with denying a treatment because an agency does feel there is sufficient benefit compared to the cost.

Though all four countries shared similar views on treatment access, the United States stood apart in one key way: Most Americans have very low confidence in a government agency to make decisions about access to the best health care even if evidence points to greater effectiveness of more costly treatments, and two-thirds of US respondents believe that the government is already denying patients care because of high treatment costs.

Dr. Selby and Dr. Blendon both point to many opportunities that CER poses to improved health care, from increasing the ability to identify subgroups of the general population in which certain treatments can have greater effectiveness, to more clearly identifying areas of need for innovation and development of new treatments, but as Dr. Selby pointed out in the discussion, the survey results emphasize very clear distinction between the American public “wanting and trusting independent evidence,” and not trusting a government entity to evaluate this evidence to make objective access decisions.

As an independent organization created “to conduct research to provide information about the best available evidence to help patients and their health care providers make more informed decisions,” the survey brings to light the challenges that PCORI will face in establishing greater transparency in health care in the United States. With PCORI’s plans to devote only 10% of its resources to communication and dissemination of research to the public, it will be interesting to see how it will rise above these challenges. For more resources on CER, visit the Alliance’s CER Repository. For the webcast press release, which includes links to the topline results and slides from Dr. Blendon’s presentation, click here.

This posting was written by Bree Bowman, project director at the Alliance