The federally-funded Patient-Centered Outcomes Research Institute — created to evaluate how effective medical interventions are compared to each other — has not consistently invested enough funds in this research, according to a report from the left-leaning Center for American Progress.
PCORI was created under the Affordable Care Act to fund more "comparative effectiveness research," something that has been lacking in the U.S., according to the report. Most research compares new drugs to a placebo rather than sizing them up to existing drugs to see if they are more cost effective solutions. As a result, more than half of medical interventions are delivered without evidence of their effectiveness, according to an estimate cited in the report from the Institute of Medicine.
The new CAP analysis found the institute has dedicated 51 percent of its funding to CER since its inception — which the center considers far below its recommended 80 percent of funding.
"Increased CER would arm healthcare consumers, providers and payers with a greater understanding of how effective treatments truly are, which potentially would improve the quality of care and reduce healthcare costs," wrote authors Ezekiel Emanuel, MD, Topher Spiro and Thomas Huelskoetter.
CAP also found PCORI has not made strides in investigating the effectiveness of many prescription drugs. Since December 2013, the institute has allotted just 11.3 percent of funding toward CER studies with at least one drug, and just half of that 11.3 percent funded studies comparing two or more drugs. While not all of PCORI's grants should be awarded to studies on drugs, the amount allocated to these studies is not proportionate to drug spending within the healthcare system, according to CAP.
However, CAP did find the institute has made progress. In a 2014 analysis, CAP found PCORI was allotting just 37 percent of its grant funding, or $171 million, to CER. The remaining funds were used for research on methodology, dissemination, communication tools and education initiatives. Following this analysis, the institute reallocated its funding so that 58 percent, or $544.7 million, was dedicated to CER.
This means over the course of PCORI's existence, it has cumulatively allocated $715.7 million to CER — or 51 percent of all grants — since it was established in 2012, according to the report.
"PCORI has made progress, but not enough — and it is running out of time. Since PCORI is only authorized under current law through 2019, it is urgent that the institute act quickly to maximize its impact," the authors wrote.
The center recommends PCORI dedicate 90 percent of funding to CER in its remaining years, which would require it to reduce or eliminate spending on methods and engagement research.
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