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Comparative Effectiveness: More About Cost or Care?

The issue of one size doesn’t fit all, how this relates to the treatment of patients, and where comparative effectiveness fits in was debated yesterday by panelists during a media event held by Cook Medical in New York City. “There are many who believe in the promise that comparative effectiveness takes us to this promise land of providing treatments that are cost effective,” said Phil Nowell, global leader of Cook Medical’s Aortic Intervention strategic business unit.

Although the main goal for Congress and policy makers is deliver data that helps doctors and patients make informed decisions, yesterday's panel of speakers proved yet again that there are still a lot of unanswered questions surrounding the matter. "In the financial industry, I think it's added a new layer of uncertainty for the public and private companies," said Amit Bhalla, director at Citigroup Investment Research (New York City). "In concept, comparative effectiveness is great--who doesn't want more data? The question is how it's going to be implemented: Is it going to be truly clinical effectiveness, or is it going to be cost effectiveness?" For physicians, the one-size-fits-all approach doesn't work. Neal Cayne, MD, expressed concern that if only devices that are more cost effective and proven medically effective than others are reimbursed, he could be limited in what devices he can use on patients. "There is clinical judgment when you're making decision about patients," said Cayne, the director of the endovascular surgery program at NYU Langone Medical Center. "I'm really concerned that I might not have the best treatment [option] for the patient." Aside from potentially inhibiting innovation, Cayne's point is amplified by the fact that comparative effectiveness and the direction of the economy could change the kind of healthcare people receive in the United States. "It's hard for me to look at a patient with a problem that I know I can fix and the technology is out there, and my hands are tied. It's very frustrating, and hopefully we can somehow adjust the monetary problem and have the care available for the individual patient that we need. But it's not going to be easy to do."

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