Comparative effectiveness research and evidence-based health policy: experience from four countries.
BACKGROUND
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.


RESULTS
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.
Chalkidou
Kalipso
K
National Institute for Health and Clinical Excellence, London, UK. kalipso.chalkidou@nice.org.uk
Tunis
Sean
S
Lopert
Ruth
R
Rochaix
Lise
L
Sawicki
Peter T
PT
Nasser
Mona
M
Xerri
Bertrand
B
D001315:Australia; D003659:Decision Making, Organizational; D004059:Diffusion of Innovation; D017598:Efficiency, Organizational; D019317:Evidence-Based Medicine / Q000191:economics / Q000458:organization & administration*; D005602:France; D005858:Germany; D006291:Health Policy; D006302:Health Services Research / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D033183:Interdisciplinary Communication; D009313:National Health Programs / Q000458:organization & administration; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D006113:United Kingdom; D014481:United States