2012-02-09 18:46:08 UTC

AGA Policy Statement on Comparative Effectiveness Research

Oct. 13, 2010

 Despite investments in biomedical research, information about the best diagnostic and treatment modalities is incomplete or unavailable. By some estimates, more than half of the treatments delivered today are without clear evidence of effectiveness. This uncertainty contributes to great variability in managing clinical problems, with costs and outcomes differing markedly across the country.1 

As part of the American Recovery and Reinvestment Act of 2009, Congress appropriated $1.1 billion to jump-start the nation’s efforts to accelerate comparative effectiveness research (CER). A major emphasis is on identifying what works for which patients under what circumstances. It is anticipated that CER will account for an increasing proportion of the federal research enterprise. 

The Institute of Medicine (IOM) was guided by the following definition of CER:

CER is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat and monitor a clinical condition, or to improve the delivery of care. The purpose of CER is to assist consumers, clinicians, purchasers and policy makers to make informed decisions that will improve health care at both the individual and population levels.

CER often includes directly comparing effective interventions, studying patients in routine clinical care and customizing decisions to the needs of individual patients. CER also includes studies of research to identify the most effective strategies for disseminating new and existing findings, and to help clinicians and organizations implement findings into daily clinical practice. The IOM developed a list of 100 priority topics for this research and made recommendations for a national system for CER. 

Among the 100 research priorities identified, many have relevance to the AGA:

  • Compare the effectiveness of upper endoscopy utilization and frequency for patients with GERD on morbidity, quality of life and diagnosis of esophageal adenocarcinoma.
  • Compare the effectiveness of different strategies of introducing biologics into the treatment algorithm for inflammatory diseases, including Crohn’s disease, ulcerative colitis, rheumatoid arthritis and psoriatic arthritis.
  • Compare the effectiveness of genetic and biomarker testing and usual care in preventing and treating breast, colorectal, prostate, lung and ovarian cancer, and possibly other clinical conditions for which promising biomarkers exist.
  • Compare the effectiveness of new screening technologies (such as fecal immunochemical tests and CT colonography) and usual care (fecal occult blood tests and colonoscopy) in preventing colorectal cancer.

The IOM panel also concluded that a robust infrastructure to advance this agenda was necessary, including development of appropriate scientific methods; involvement of consumers, patients and caregivers in strategic planning; the creation of electronic data networks; and workforce development. 

The AGA encourages CER. It is important that members of the AGA actively generate new evidence and participate in the priority setting process over the coming years.  |



1. Initial National Priorities for Comparative Effectiveness Research. National Academies Press, June 2009.


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