Institute for Clinical and Economic Review (ICER), Massachusetts General Hospital Institute for Technology Assessment, Boston, MA 02114, USA.
Med Care. 2010 Jun;48(6 Suppl):S145-52. doi: 10.1097/MLR.0b013e3181d9913b.
An important challenge facing the research community is how to make comparative effectiveness reviews "fit for purpose"--how to translate the results into a format that can provide actionable guidance for all stakeholders trying to improve the quality and value of health care.
To communicate transparently the overall judgments on the findings from a comparative effectiveness review, the Institute for Clinical and Economic Review (ICER) uses an integrated evidence rating that combines separate ratings of comparative clinical effectiveness and comparative value. These integrated ratings look somewhat like bond ratings, and are suited to foster more direct consideration by all decision makers for potential application to patient information, clinical guidelines, and value-based coverage and payment policies.
ICER Integrated Evidence Ratings have supported coverage decision-making processes in a limited number of public and private payers, and demonstration efforts are underway to link reviews to patient information and revised payment policies. Several important challenges to rating have been encountered and addressed. Early feedback has suggested that the rating format helps decision makers understand the key issues underlying judgments about the comparative effectiveness of alternative interventions.
Decision makers need comparative effectiveness reviews to be objective and rigorous; they also need key judgments regarding the evidence to be translated so all stakeholders can understand and consider them fully. A rating format that captures key judgments about comparative clinical effectiveness and comparative value could prove an effective method for helping ensure that comparative effectiveness reviews are understandable and useful to all stakeholders.
研究界面临的一个重要挑战是如何使有效性比较研究“切合实际”——如何将研究结果转化为一种格式，为所有试图提高医疗保健质量和价值的利益相关者提供可操作的指导。
为了透明地传达对比较有效性研究结果的总体判断，临床与经济评价研究所（ICER）使用综合证据评级，将比较临床有效性和比较价值的单独评级结合起来。这些综合评级看起来有点像债券评级，适合促进所有决策者更直接地考虑将其应用于患者信息、临床指南以及基于价值的覆盖范围和支付政策。
ICER 综合证据评级已经支持了少数公共和私人支付者的覆盖决策过程，并且正在进行示范努力，将审查结果与患者信息和修订后的支付政策联系起来。已经遇到并解决了一些重要的评级挑战。早期的反馈表明，评级格式有助于决策者理解替代干预措施的比较有效性判断背后的关键问题。
决策者需要比较有效性研究具有客观性和严谨性；他们还需要对证据进行关键判断，以便所有利益相关者都能充分理解和考虑这些判断。一种能够捕捉比较临床有效性和比较价值的关键判断的评级格式，可能是帮助确保比较有效性研究对所有利益相关者都具有可理解性和有用性的有效方法。
