Comparative Effectiveness Research and Evidence‐Based Health Policy: Experience from Four Countries

Abstract

Context:The discussion about improving the efficiency, quality, and long-term sustainability of the U.S. health care system is increasingly focusing on the need to provide better evidence for decision making through comparative effectiveness research (CER). In recent years, several other countries have established agencies to evaluate health technologies and broader management strategies to inform health care policy decisions. This article reviews experiences from Britain, France, Australia, and Germany.Methods: This article draws on the experience of senior technical and administrative staff in setting up and running the CER entities studied. Besides reviewing the agencies' websites, legal framework documents, and informal interviews with key stakeholders, this analysis was informed by a workshop bringing together U.S. and international experts.Findings: This article builds a matrix of features identified from the international models studied that offer insights into near-term decisions about the location, design, and function of a U.S.-based CER entity. While each country has developed a CER capacity unique to its health system, elements such as the inclusiveness of relevant stakeholders, transparency in operation, independence of the central government and other interests, and adaptability to a changing environment are prerequisites for these entities' successful operation. Conclusions:While the CER entities evolved separately and have different responsibilities, they have adopted a set of core structural, technical, and procedural principles, including mechanisms for engaging with stakeholders, governance and oversight arrangements, and explicit methodologies for analyzing evidence, to ensure a high-quality product that is relevant to their system.

Policies, Management and Innovation Research Groups for Nursing Excellence

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Taking Stock of the Ethical Foundations of International Health Research: Pragmatic Lessons from the IU–Moi Academic Research Ethics Partnership

“…As described in a companion article in this Supplement, AMPATH's research mission is as impressive in its collaborations as it is in the scope of the projects themselves: clinical trials; health information database studies; community-based trials of innovative care delivery; multiple health services projects, and newer efforts emerging in public health and genetic studies. 35 Each of these designs, and others such as comparative effectiveness studies 36 raise challenging bioethical questions in international collaborations. So it is noteworthy, that even before this growth in research within AMPATH, its leadership recognized the need for attention to bioethics issues.…”

A regulatory governance perspective on Health Technology Assessment (HTA) in Sweden

“…We 10 conclude that a regulatory governance approach to the analysis of national processes for 11 HTA has the capacity to draw attention to a new range of challenges and issues which 12 have direct relevance to improving the conduct of HTA within national regulatory spaces. 13 Pharmaceutical Benefits Agency (TLV) in Sweden and the National Institute for Health 42 and Care Excellence (NICE) in England.…”

“…Some compare 119 national studies emphasizing themes like competition and privatization. And others often 120 take a specific medical theme as the focus of their analysis, such as oncology or diabetes 121 [11,12,13]. 122…”