Comparative Effectiveness Research

Abstract

Comparative effectiveness research (CER) compares the real-world outcomes resulting from alternative treatment options that are available for a given medical condition. Its key elements include the study of effectiveness (effect in the real world), rather than efficacy (ideal effect), and that it compares among alternative strategies. CER includes three key elements: (i) evidence synthesis (identifying and summarizing already extant data addressing a question); (ii) evidence generation (creating new data addressing a question); and (iii) evidence dissemination (distributing the available data, with the goal of modifying patient care). The primary goal of CER is to increase the use of scientific evidence to inform clinical decisions and improve patient care. In the process, the hope is that it will rationalize and thereby potentially reduce the cost of medical care. To date, most CER has compared among alternative drugs, so it is of particular relevance to pharmacoepidemiology. This chapter reviews the history of CER, the numerous clinical and methodologic issues involved in undertaking CER activities, examples of current applications, and thoughts about reasonable expectations in the future.

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