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An Integrated Evidence Rating to Frame Comparative Effectiveness Assessments for Decision Makers

Ollendorf, Daniel A. MPH; Pearson, Steven D. MD, MSc

doi: 10.1097/MLR.0b013e3181d9913b
Comparative Effectiveness

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

From the Institute for Clinical and Economic Review (ICER), Massachusetts General Hospital Institute for Technology Assessment, Boston, MA.

Reprints: Steven D. Pearson, MD, MSc, Institute for Clinical and Economic Review, 101 Merrimac St., 10th Floor, Boston, MA 02114. E-mail: spearson@icer-review.org.

© 2010 Lippincott Williams & Wilkins, Inc.