Comparative effectiveness research: Relevance and applications to pharmacy

Purpose. An overview of the emerging field of comparative effectiveness research (CER) and its relevance to pharmacists and pharmacy-based decision-makers is provided. Summary. The U.S. government is investing over $1 billion on CER over the next two years. This investment is in part driven by the recognition that, despite having the highest per capita health care expenditures in the world, the United States does not always perform well on measures of health compared with other countries. There also is increased awareness of the limited information provided by results of traditional randomized clinical trials to inform decisions about therapeutic alternatives as applied in actual practice. Comparative effectiveness studies have two important principal components: (1) the comparison of two or more agents or interventions that are considered true therapeutic alternatives and (2) the examination of effects (outcomes) in actual practice. Comparative effectiveness studies differ from traditional efficacy studies in several ways, including the research question addressed, comparison groups, patient population, setting, outcomes measured, and validity. Studies that are within the scope of CER can be categorized as primary comparative effectiveness studies or secondary comparative effectiveness studies. CER also can be used to compare medical devices, procedures, health services, or any competing intervention. Conclusion. Comparative effectiveness is an emerging area of research relevant to many areas of health care, especially pharmacotherapy. The knowledge gained from CER is important to pharmacists when applying drug information and making decisions related to drug therapy.