Cost-Effectiveness Information: Yes, It's Important, but Keep It Separate, Please!

In this issue, the American College of Physicians (ACP) makes a series of compelling statements and recommendations about the need for better information on comparative effectiveness if the United States is to make more effective and efficient use of its limited health care resources (1). The term limited seems incongruous when applied to a country that is currently spending $2 trillion on health care, yet I believe that as much as we spend now, we would spend more if resources were not in some way constrained.

The ACP agrees with other commentators that the United States needs to invest substantially in a national entity that would generate information on clinical comparative effectiveness and that the scope of this new entity should include the relative clinical effectiveness and safety of any 2 or more medical services, drugs, devices, therapies, or procedures used to treat the same condition. The ACP goes beyond others by recommending that the scope should include cost-effectiveness. It concludes that the United States spends too little on developing comparative effectiveness data; that it fails to coordinate or prioritize the production of comparative effectiveness information; and that its failure to use information on cost-effectiveness affects the ability of payers, physicians, and patients to make effective, informed choices that optimize the value received for health care dollars spent.

These conclusions frustrate me. Although I firmly support them, I adamantly oppose the ACP's …