Session Summary: ISCTM 2010 National Mental Health Research-to-Policy Forum: The Role of Comparative Effectiveness Research in Future Mental Health Policy Decision Making

Chairmen:  Reuven Ferziger MD, J&J North American Pharmaceuticals; Ronald Manderscheid PhD, SRA International; D Steinwachs PhD, Johns Hopkins University; Benjamin Druss MD, MPH, Emory University

Speakers:  Bryan Luce PhD, MBA, United Biosource Corporation; Michael Rawlins MD, National Institute for Health and Clinical Excellence (NICE); Richard Frank MD, Harvard Medical School

Discussants:  Jean Slutsky PA, MSPH, Agency for Health Care Research and Quality; M Schoenbaum PhD, National Institute of Mental Health; David Shern PhD, Mental Health America; M Rawlins MD, National Institute for Health and Clinical Excellence (NICE); K Broich MD, Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte); Joseph Parks MD, Missouri Department of Mental Health; D Jarvis CPA, MCPP Healthcare Consulting, Inc.; S Leff PhD, University of Pennsylvania

Summary

This program gathered experts in CNS trial methodology and policy-makers from the US and Europe to focus on policy implications of Comparative Effectiveness Research (CER) for the treatment of psychiatric diseases, and development of scientific methodologies needed to conduct and utilize CER studies of psychiatric treatments for diseases such as schizophrenia, bipolar disorder, autism and depression, which are among the most costly problems in health care.

CER 2010: Overview and Critical Review of the Current Science and Politics of Comparative Effectiveness
B Luce, PhD, MBA
This comprised a general overview, including definitions of CER, and an historical overview.
Federal efforts failed; private sector efforts, and ExUS efforts, have been more successful (e.g. NICE, the National Institute for Health and Clinical Excellence).

Since 1990, deepening US commitment has taken several forms: the Agency for healthcare quality & research; Medicare evidence development & coverage advisory committee; CER stimulus funds; the health reform legislation includes CER institute & Medicare commission.

The political lesson seems to be:  develop evidence at arm’s length from policy; exclude cost-related analyses; sell Medicare’s conditional coverage policy as a positive way to cover new technology; capitalize on the perceived success of NIH comparative trials, and the increased concern about the cost of health care.

Keynote Address: The Role of CER in Future Mental Health Policy Decision Making
Michael Rawlins, MD
Comparative Effectiveness Research is becoming an emphasis of legislation and future policies to establish the value of different therapies, services and systems approaches to care.  In this session, leaders in mental health and leaders in the development of CER will address questions like:  What are the urgent mental health questions that would be addressed by CER for mental health?  How should these questions be prioritized?  What are the present capabilities and unmet needs for CER studies in mental health?  What research disciplines need to be engaged and how should they collaborate? How can mental health stakeholders and policy makers insure that particular CER approaches to mental illness are methodologically sound?  That they account for the diversity of people with mental illness and the range of settings of mental health care?  Should CER be used to inform only quality of care or also cost effectiveness?  What can we learn from the experience of NICE in the UK?  How do leaders in US healthcare policy view the potential of CER to improve care for people with mental illnesses?