Lessons from Abroad (Essay‪)‬

Comparative effectiveness research is a relatively new term in U.S. health policy discourse, but the concept has been embraced for years by many other countries. Some of them, like the United Kingdom, have single-payer systems, whereas others have insurance-based ones--for example, Germany (with a predominantly public insurance system) and the Netherlands (where private insurers play a larger role). Two reviews published earlier this year in the Milbank Quarterly and the Euro Observer assessed how comparative effectiveness research is used in Australia, France, Germany, the Netherlands, Sweden, and the United Kingdom. (1) They concluded that health technology assessment (HTA) systems have played central, if not transformative, roles in contributing to evidence-based decision-making and in identifying interventions that provide the most value for money. For each of the countries studied, the hub of comparative effectiveness research is an HTA agency, although the scope of its assessments varies from country to country. Australia's Pharmaceutical Benefits Scheme (PBS), for example, concentrates on pharmaceuticals only, whereas the French Haute Autorite de Sante (HAS) and the United Kingdom's National Institute for Health and Clinical Excellence (NICE) assess a wide range of other measures--the latter, for instance, evaluating treatments, diagnostic tests, procedures, medical devices, and public health programs. The agencies also differ in the extent and methods of considering the costs of interventions: while NICE has been charged from its inception with taking cost into account, other HTAs have begun to do so only recently.