, Volume 72, Issue 2, pp 163–170 | Cite as

Translating Comparative Effectiveness Research into Clinical Practice

The UK Experience
Current Opinion


Comparative effectiveness research (CER) is not new but its potential to improve the effectiveness of healthcare has not yet been exploited in the US. Other countries such as the UK have more experience of this. Key points of the UK experience are summarized here and some possible pointers for the US are drawn. These include the following: how to go beyond the evidence and apply judgements to make recommendations with authority and in a timely manner; how to implement these recommendations; how to identify suitable topics; and how to be open and transparently fair to all stakeholders. The quality of the science of CER is key but this needs developing, and not ust in biomedical or statistical terms but also in how to understand public expectations, and how to implement its recommendations.

A key issue is the role of health economics, which seems to have been marginalized by the CER legislation, but perhaps this is more apparent than real. Clearly this is a matter for much further debate. It is hard to see how CER can deliver its potential without active consideration of both benefits and costs.

Although other countries have more experience of this than does the US, the context for such work is always very specific and the US will have to find its own way, while trying to avoid some of the errors made elsewhere.


  1. 1.
    American Recovery and Reinvestment Act of 2009, HR1, 111th CongGoogle Scholar
  2. 2.
    Ommaya AK, Kupersmith J. Challenges facing the US Patient-Centered Outcomes Research Institute. JAMA 2011; 306: 756–7PubMedCrossRefGoogle Scholar
  3. 3.
    Washington AE, Lipstein SH. The Patient-Centered Outcomes Research Institute: promoting better information, decisions, and health. N Engl J Med 2011 Oct 13; 365(15): e31PubMedCrossRefGoogle Scholar
  4. 4.
    Martin DF, Maguire MG, Fine SL. Identifying and eliminating the roadblocks to comparative-effectiveness research. N Engl J Med 2010; 363(2): 105–7PubMedCrossRefGoogle Scholar
  5. 5.
    Lauer MS, Collins FS. Using science to improve the nation’s health system: NIH’s commitment to comparative effectiveness research. JAMA 2010; 303(21): 2182–3PubMedCrossRefGoogle Scholar
  6. 6.
    Chalkidou K, Walley T. Using comparative effectiveness research to inform policy and practice in the UK NHS: past, present and future. Pharmacoeconomics 2010; 28(10): 799–811PubMedCrossRefGoogle Scholar
  7. 7.
    Walley T. Health technology assessment in England: assessment and appraisal. Med J Aust 2007; 187(5): 283–5PubMedGoogle Scholar
  8. 8.
    Devlin N, Sussex J. Incorporating multiple criteria in HTA methods and processes. London: Office of Health Economics, 2011 MarGoogle Scholar
  9. 9.
    Kennedy I. Appraising the value of innovation and other benefits: a short study for NICE. London: NICE, 2009 [online]. Available from URL: http://www.nice.org.uk/media/98F/5C/KennedyStudyFinalReport.pdf [Accessed 2011 Dec 20]
  10. 10.
    Lumley T. Network meta-analysis for indirect treatment comparisons. Stat Med 2002; 21: 2313–24PubMedCrossRefGoogle Scholar
  11. 11.
    NIHR Health Technology Assessment programme [online]. Available from URL: http://www.hta.ac.uk [Accessed 2011 Dec 28]
  12. 12.
    Rawlins M. De testimonio: on the evidence for decisions about the use of therapeutic interventions. Lancet 2008; 372(9656): 2152–61PubMedCrossRefGoogle Scholar
  13. 13.
    Haycox A. Does ‘NICE blight’ exist, and if so, why? Pharmacoeconomics 2008; 26(12): 987–9PubMedCrossRefGoogle Scholar
  14. 14.
    Briggs A, Ritchie K, Fenwick E, et al. Access with evidence development in the UK: past experience, current initiatives and future potential. Pharmacoeconomics 2010; 28(2): 163–70PubMedCrossRefGoogle Scholar
  15. 15.
    National Institute for Health and Clinical Excellence. Claxton K. Informing a decision framework for when NICE should recommend the use of health technologies only in the context of an appropriately designed programme of evidence development [research in progress; online]. Available from URL: http://www.nice.org.uk/aboutnice/howwework/researchanddevelopment/ResearchProjectHealthTechnologies.jsp [Accessed 2011 Sep 22]
  16. 16.
    Institute for Clinical and Economic Review. First public meeting of New England Comparative Effectiveness Public Advisory Council (CEPAC) set for Saturday, June 11, 2011 [online]. Available from URL: http://www.icer-review.org/index.php/Announcements/cepacjune11.html [Accessed 2011 Sep 17]
  17. 17.
    Patient-Centered Outcomes Research Institute. Funding opportunities [online]. Available from URL: http://www.pcori.org/funding-opportunities/ [Accessed 2011 Sep 22]
  18. 18.
    The NHS Information Centre for Health and Social Care. Use of NICE-appraised medicines in the NHS in England — 2009, experimental statistics. London: NHS Information Centre, 2011 [online]. Available from URL: http://www.ic.nhs.uk/webfiles/publications/007_Primary_Care/niceappmed0910/NICE_bulletin_2009.pdf [Accessed 2011 Dec 20]
  19. 19.
    NHS Information Centre for Health and Social Care. Hospital prescribing, England: 2010 [online]. Available from URL: http://www.ic.nhs.uk/webfiles/publications/007_Primary_Care/Prescribing/Hospital%20Prescribing%202010/Hospital_prescribing_bulletin_England_2010.pdf [Accessed 2011 Dec 20]
  20. 20.
    National Institute for Health and Clinical Excellence. ERNIE: Evaluation and Review of NICE Implementation Evidence [online]. Available from URL: http://www.nice.org.uk/usingguidance/evaluationandreviewofniceimplementationevidenceernie/searchernie/search_ernie.jsp [Accessed 2011 Dec 28]
  21. 21.
    Lillis M. Baucus scores a big win for big pharma. Washington Independent 2009 Sep 24 [online]. Available from URL: http://washingtonindependent.com/60782/baucus-scores-a-win-for-big-pharma [Accessed 2011 Sep 22]
  22. 22.
    Kendall T, McGoey L, Jackson E. If NICE was in the USA. Lancet 2009 Jul 25; 374(9686): 272–3PubMedCrossRefGoogle Scholar
  23. 23.
    Breckenridge A, Woods K, Walley T. Medicines regulation and health technology assessment. Clin Pharmacol Ther 2010; 87: 152–4PubMedCrossRefGoogle Scholar
  24. 24.
    Faden RR, Chalkidou K. Determining the value of drugs: the evolving British experience. N Engl J Med 2011; 364: 1289–91PubMedCrossRefGoogle Scholar
  25. 25.
    Institute of Medicine of the National Academies. Initial national priorities for comparative effectiveness research. Washington, DC: IOM, 2009 [online]. Available from URL: http://iom.edu/Reports/2009/ComparativeEffectivenessResearchPriorities.aspx [Accessed 2011 Sep 22]
  26. 26.
    Garber AM, Sox HC. The role of costs in comparative effectiveness research. Health Aff [Millwood] 2010; 29: 1805–11CrossRefGoogle Scholar
  27. 27.
    Maynard A, Bloor K. The future role of NICE. BMJ 2010; 341: c6286PubMedCrossRefGoogle Scholar
  28. 28.
    NIHR Health Technology Assessment programme. Health technology assessment: the internationally acclaimed journal series of the HTA programme [online]. Available from URL: http://www.hta.ac.uk/research/HTAjournal.shtml [Accessed 2011 Dec 29]
  29. 29.
    National Institute for Health and Clinical Excellence. Updated guide to the methods of technology appraisal. London: NICE, 2008 Jun [online]. Available from URL: http://www.nice.org.uk/aboutnice/howwework/devnicetech/technologyappraisalprocessguides/guidetothemethodsoftechnologyappraisal.jsp [Accessed 2011 Sep 22]

Copyright information

© Adis Data Information BV 2012

Authors and Affiliations

  1. 1.HTA Programme, National Institute for Health Research, c/o The Old InfirmaryUniversity of LiverpoolLiverpoolUK

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