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    American Urological Association submits comparative effectiveness wish list

    Top priorities include PCa treatments, imaging studies

    Bob Gatty
    Washington—The federal government has launched a new initiative designed to provide systematic research comparing different interventions and strategies to diagnose, treat, and monitor health conditions, with $1.1 billion provided by the American Reinvestment & Recovery Act of 2009.

    Because this Comparative Effectiveness Research (CER) initiative will affect virtually every major medical condition and the health care providers who treat them, AUA quickly recommended three areas for CER investigation and submitted a statement in mid-May to the Federal Coordinating Council for Comparative Effectiveness Research, established by the Department of Health & Human Services (HHS) to help coordinate research and guide its investments in CER.

    In its written statement, AUA "heartily endorse(s) the Administration's focus on comparative effectiveness research as an evidence-based, systematic way to identify the best treatments for specific patient populations and to generate the critical information that will help guide both physicians and patients through the complex decision process to select the most appropriate treatment."

    The areas nominated by AUA for CER investigation were prostate cancer treatment, "sustained public/private support for a robust quality infrastructure," and a comparison of imaging modalities for major urologic conditions.

    Prostate cancer treatment

    AUA reported that in 2008, an estimated 200,000 men were newly diagnosed with prostate cancer in the U.S. and about 29,000 men died from the disease; in addition, significant prostate cancer disparities exist between rural and urban populations and across racial and ethnic groups.

    How CER* funding is allocated
    The organization said studies have demonstrated that patients with prostate cancer in rural areas are more likely to be diagnosed at later stages, receive different management of their disease, be uninsured or underinsured, and have less-desirable outcomes than their urban counterparts.

    African-American men, meanwhile, experience prostate cancer mortality rates more than double those observed in other racial and ethnic groups and, compared to Caucasian men, they are less likely to receive treatment, especially when diagnosed with more advanced cancer, according to AUA. In addition, while PSA testing has improved early detection of prostate cancer, PSA is not equally available to all populations.

    AUA also pointed out that prostate cancer is a focus of the Medicare program, and it is one of eight high-cost conditions selected for the Physician Resource Utilization Report pilot program authorized in the Medicare Improvements for Patients and Providers Act of 2009.

    "Despite its prevalence, cost, and complexity, there is a distinct lack of evidence comparing the treatment options for localized prostate cancer," Aua asserted.

    AUA said CER studies "should compare long-term treatment option outcomes such as overall survival, quality of life and patient satisfaction for different patient populations (eg, age, race, tumor characteristics, genetic profile, etc)."

    In its statement, AUA observed that all health care reform proposals are predicated on the presumption that a robust, well-developed quality infrastructure exists. However, it said, "The infrastructure varies substantially by provider type (eg, hospital, dialysis facility, specialist physicians) and condition (eg, diabetes, cardiovascular disease, prostate cancer)." Thus, basic research must provide the evidence needed to formulate clinical guidelines, a prerequisite for the development of quality performance measures, AUA said. Clinical registries can provide data to revise guidelines, test measures, provide comparative performance information and benchmarks, identify areas for quality improvement, and highlight areas for additional research.

    "We ask for support for the development and maintenance of the quality infrastructure through creation of a public/private partnership under the auspices of AHRQ [Agency for Healthcare Research and Quality] or NIH," AUA said, noting that resources could come from public and private stakeholders, including government, business, private insurers, research entities, and medical specialty societies.

    Comparison of imaging modalities

    After observing that analyses conducted for the federal government have established "that at least some portion of the rapid rate of increase in physician-ordered imaging services is attributable to duplicative or inappropriate imaging," AUA said it is launching a comparative effectiveness study of imaging modalities for ureteral stones, with the intent of producing evidence-based guidance on the most effective and efficient imaging for this condition. Data will be disseminated to urologists and others who treat the condition.

    In total, the America Reinvestment & Recovery Act appropriated $300 million for AHRQ, $400 million for the NIH, and $400 million for HHS to support comparative effectiveness research efforts. The Council will provide input on priorities for the $400 million allocated to HHS.

    Bob Gatty , a former congressional aide, covers news from Washington for Urology Times.

    Bob Gatty
    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.


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