title: Medical and pharmacy coverage decision making at the population level.
abstract: Medicare is one of the largest health care payers in the United States. As a result, its decisions about coverage have profound implications for patient access to care. In this commentary, the authors describe how Medicare used evidence on heterogeneity of treatment effects to make population-based decisions on health care coverage for implantable cardiac defibrillators. This case is discussed in the context of the rapidly expanding availability of comparative effectiveness research. While there is a potential tension between population-based and patient-centered decision making, the expanded diversity of populations and settings included in comparative effectiveness research can provide useful information for making more discerning and informed policy and clinical decisions.
authors.affiliation: Center for Medical Technology Policy, 401 E. Pratt, Ste. 631, Baltimore, MD 21202. penny.mohr@cmtpnet.org.
authors.forename: Penny E
authors.initials: PE
authors.lastname: Mohr
authors.forename: Sean R
authors.initials: SR
authors.lastname: Tunis
mesh_terms: D057186:Comparative Effectiveness Research; D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000191:economics; D004554:Electric Countershock / Q000191:economics / Q000295:instrumentation*; D019317:Evidence-Based Medicine; D017048:Health Care Costs; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D007356:Insurance, Pharmaceutical Services / Q000191:economics; D006278:Medicare / Q000191:economics; D018579:Patient Selection; D010593:Pharmaceutical Services / Q000191:economics; D044382:Population Groups; D016896:Treatment Outcome; D014481:United States