Priorities for Comparative Effectiveness Research

Perhaps no single health-related component of the American Recovery and Reinvestment Act of 2009 (ARRA) has received more attention than the $1.1 billion appropriation for comparative effectiveness research, or CER.  CER is a type of clinical or public health research that directly informs clinical practice or public policy.  Specifically, CER involves real-world comparisons of different existing strategies for prevention, treatment, or management of disease.  Even before the American Recovery and Reinvestment Act of 2009, the NHLBI has had a long and proud history in CER, supporting major trials like Cardiac Arrhythmia Suppression Trial (CAST),  Antihypertensive and Lipid-lowering Treatment to Prevent Heart Attack Trial (ALLHAT), Sudden Cardiac Death in Heart Failure (SCD-HeFT), and most recently the BARI 2D trial of therapies for diabetes and coronary artery disease.

Congress appropriated $1.1 billion for CER, with $400 million going to NIH.  To help the government align its priorities with national needs, the legislation created two panels charged with advising the Secretary of HHS, the President, and the Congress.  The Institute of Medicine (IOM) convened a panel to identify specific topics for study, while a “Federal Coordinating Council” (FCC) of senior Federal officials (including Dr. Elizabeth Nabel, Director of NHLBI) met to inventory and articulate major gaps in Federal CER efforts.   The IOM and FCC issued their reports on June 30, 2009.

The IOM report identified 100 top national priorities for CER topics (Figure).  Cardiovascular disease had the second most frequent number of “primary research” topics and the most of any organ system or disease area.  Among the listed cardiovascular topics were treatments for atrial fibrillation, mindfulness-based interventions for cardiovascular risk factors, optimal management of stable coronary disease, innovative treatments for heart failure, and strategies for assessing asymptomatic coronary atherosclerosis. 

In future postings, we will discuss the other major ARRA CER report from the FCC and highlight major NHLBI CER projects that will be funded by the American Recovery and Reinvestment Act of 2009.  The ARRA CER appropriation provides an exciting opportunity to enhance a critically important component of our nation’s biomedical research agenda.

Source: The National Academy of Sciences, Courtesy of the National Academies Press, Washington, D.C., Figure 5-1, Initial National Priorities for Comparative Effectiveness Research, 2009.