Comparative Effectiveness Research Not Aligned with Financial Incentives

The RAND researchers picked six major studies from the last decade that produced findings that should have dramatically altered the way patients with certain conditions, such as stable coronary artery disease, schizophrenia, hypertension, or lumbar spinal stenosis, should be treated.

They then identified several steps by which traditional research should be translated into practice, for example, from interpretation to formalization—when the findings are converted to guidelines and performance measures or clinical decision support tools—to dissemination to implementation.

But after three of the studies, there was "no change in practice," and in two there was merely "some" or "little change" in practice or "slow adoption."

For example, the ALLHAT (Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial), published in 2002, found that for patients with hypertension and at least one other cardiovascular disease risk factor, "less costly, traditional diuretics are more effective than newer medicines at lowering high blood pressure and preventing some forms of heart disease," according to the National Heart, Lung, and Blood Institute.

Timbie, however, found that these less expensive diuretics "are adopted much more slowly than heavily marketed treatments that are less effective."

Similarly, the 2007 COURAGE trial, (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) revealed that medical therapy and percutaneous coronary intervention (PCI) did not provide patients with better survival benefit and angina relief than medical therapy alone.  Yet there has been "little or no change in practice," Timbie says.