Comparative effectiveness is a measurement concept embraced by President Obama and the Administration as a means of containing costs while improving the quality of healthcare services. The role of the organizations involved in CE research is to generate comparisons between the relative effectiveness of various care (or system) interventions and their relative prices. When completed, health consumers will be able to apply the measures developed through CE research to choose not only the most effective methods of care, but also to obtain their choices at the most reasonable prices.

I spoke to the Council on behalf of the 107 mental health and substance use prevention and treatment organizations that comprise the Whole Health Campaign. As you will recall, the Campaign seeks good universal health insurance coverage, good integrated care, and good prevention services for persons with mental or substance use conditions. It strongly supports National Health Reform and has prepared nine detailed policy analyses that address key topics of reform (see www.wholehealthcampaign.org).

In my testimony, I emphasized that the comparative effectiveness research enterprise must:

Be guided by consumer and family input. Consumers and families have the direct, lived experience of major health problems, as well as direct experience with successful and failed interventions. They can provide important and needed advice on priority setting and ongoing operations.

Build infrastructure and train researchers. Currently, the mental health and substance use prevention and treatment fields lack the infrastructure and trained personnel to undertake comparative effectiveness research and bring needed innovation to the field. Very few comparative effectiveness studies have been done for either field. It is critical that the mental health and substance use fields not become backwaters in an ocean of progress: We do know that a person cannot have good health without also having good mental and addictive health. Hence, developing appropriate research infrastructure to develop effective interventions for the mental health and substance use fields will be important to the entire health enterprise.

Be designed broadly. Specifically, it must span treatment, prevention, promotion, and health determinant interventions designed both for persons and for populations. To achieve better balance in expenditures on person and population interventions, at least one-quarter of federal comparative effectiveness research expenditures should be devoted to population interventions.

Comparative effectiveness research also must span traditional research boundaries. For example, we need to be able to understand the joint effects of targeted depression and diabetes treatments, since these conditions very frequently co-occur together. Failure to consider such joint effects in the past has resulted in a situation where public mental health clients die 25 years prematurely. Similar urgent needs to examine joint effects of interventions exist in the substance use field.

 

Ronald W. Manderscheid, PhD, worked for more than 30 years in the federal government on behavioral health research and policy. He is the Executive Director of the National Association of County Behavioral Health and Developmental Disability Directors as well as a member of Behavioral Healthcare's Editorial Board.