Pain Management Center of Paducah, Paducah, KY, USA.
Pain Physician. 2010 Jan-Feb;13(1):E23-54.
While the United States leads the world in many measures of health care innovation, it has been suggested that it lags behind many developed nations in a variety of health outcomes. It has also been stated that the United States continues to outspend all other Organisation for Economic Co-operation and Development (OECD) countries by a wide margin. Spending on health goods and services per person in the United States, in 2007, increased to $7,290 - almost 2(1/2) times the average of all OECD countries. Rising health care costs in the United States have been estimated to increase to 19.1% of gross domestic product (GDP) or $4.4 trillion by 2018. The increases are illustrated in both public and private sectors. Higher health care costs in the United States are implied from the variations in the medical care from area to area around the country, with almost 50% of medical care being not evidence-based, and finally as much as 30% of spending reflecting medical care of uncertain or questionable value. Thus, comparative effectiveness research (CER) has been touted by supporters with high expectations to resolve most ill effects of health care in the United States and provide high quality, less expensive, universal health care. CER is defined as the generation and synthesis of evidence that compares the benefits and harms of alternate methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. The efforts of CER in the United States date back to the late 1970's even though it was officially born with the Medicare Modernization Act (MMA) and has been rejuvenated with the American Recovery and Reinvestment Act (ARRA) of 2009 with an allocation of $1.1 billion. CER has been the basis for health care decision-making in many other countries. According to the International Network of Agencies for Health Technology Assessments (INAHTA), many industrialized countries have bodies that are charged with health technology assessments (HTAs) or comparative effectiveness studies. Of all the available agencies, the National Institute for Health and Clinical Excellence (NICE) of the United Kingdom is the most advanced, stable, and has provided significant evidence, though based on rigid and proscriptive economic and clinical formulas. While CER is making a rapid surge in the United States, supporters and opponents are expressing their views. Part I of this comprehensive review will describe facts, fallacies, and politics of CER with discussions to understand basic concepts of CER.
虽然美国在医疗保健创新的许多指标上处于领先地位，但有人认为，在各种健康结果方面，它落后于许多发达国家。还有人说，美国继续以很大的优势超过所有其他经济合作与发展组织（经合组织）国家。2007 年，美国人均用于医疗保健商品和服务的支出增加到 7290 美元——几乎是经合组织所有国家平均水平的两倍半。据估计，到 2018 年，美国医疗保健费用将增加到国内生产总值（GDP）的 19.1%，或 4.4 万亿美元。公共和私营部门都出现了这种增长。全国各地医疗保健的差异意味着美国的医疗保健费用较高，全国各地的医疗保健有近 50%没有基于证据，最后多达 30%的支出反映了不确定或有问题的医疗保健价值。因此，比较效果研究（CER）得到了支持者的高度期望，他们希望解决美国医疗保健的大多数负面影响，并提供高质量、低成本、全民医疗保健。CER 被定义为生成和综合证据，比较预防、诊断、治疗和监测临床情况或改善护理提供的替代方法的益处和危害。美国的 CER 努力可以追溯到 20 世纪 70 年代后期，尽管它是在《医疗保险现代化法案》（MMA）正式诞生的，并且在 2009 年的《美国复苏与再投资法案》（ARRA）中得到了振兴，拨款 11 亿美元。CER 一直是许多其他国家医疗保健决策的基础。根据国际卫生技术评估机构网络（INAHTA），许多工业化国家都有负责卫生技术评估（HTA）或比较效果研究的机构。在所有可用的机构中，英国的国家卫生与临床优化研究所（NICE）是最先进、最稳定的，并且提供了重要的证据，尽管是基于严格和规定性的经济和临床公式。虽然 CER 在美国迅速崛起，但支持者和反对者都表达了他们的观点。本综述的第一部分将描述 CER 的事实、谬论和政治，并进行讨论以了解 CER 的基本概念。
