Comparative Effectiveness Research Helps Improve Patient Outcomes

At its most basic level, comparative effectiveness research (CER) is about understanding what works best for patients. First defined in 2009 as part of the American Reinvestment and Recovery Act, CER aims to fill the gaps in knowledge that add uncertainty to everyday decision-making in health care.

Unlike traditional clinical research, the knowledge gained from CER should, in a transparent way, inform and improve health care decisions when multiple treatment options are available. Researchers use CER to compare the benefits and drawbacks of different interventions and strategies to prevent, diagnose, treat and monitor health conditions in real-world settings.

“CER entails comparisons whenever there is more than one management approach available and there are questions about which one yields better outcomes of interest,” said Stella Kang, MD, a radiologist at the NYU School of Medicine. “Performing a head-to-head comparison of two or more available strategies is the most direct way of identifying the most effective diagnostic tests or treatment.”

CER Plays Important Role in Radiology

Because a well-designed CER study can ultimately guide practice, policy and future research, it has an important role to play in radiology, said Christoph Lee, MD, a professor of radiology at the University of Washington. For example, CER is useful in demonstrating which new or emerging imaging technologies provide greater benefit at reasonable costs.

“CER is often necessary before policymakers can change practice guidelines or third-party payers decide to cover a new imaging technology,” Dr. Lee said. “Without studies that assess the outcomes of imaging, we may leave decision makers with an incomplete understanding of the role of imaging for a particular indication or type of radiology procedure compared with others,” said Dr. Kang, a faculty member for the RSNA/American Society of Neuroradiology (ASNR) Comparative Effectiveness Research Training (CERT) program.

Both Drs. Kang and Lee say CER is an effective tool in their research. For example, Dr. Kang and colleagues employed CER in a 2019 Radiology study comparing the effectiveness of personalized treatment for small renal tumors to routine partial nephrectomy, accounting for various competing causes of mortality.

Results showed that personalized treatment offers substantial extension of life expectancy over routine partial nephrectomy in patients with small renal tumors.

CER was also key to a 2015 Radiology study by Dr. Lee and colleagues who evaluated the effectiveness of combined biennial digital mammography and tomosynthesis screening compared with biennial digital mammography screening alone among women with dense breasts.

“My collaborators and I used CER methods to demonstrate that digital breast tomosynthesis (DBT) is likely cost effective when applied to women with dense breasts,” he said.

The study, along with other corroborating evidence, has since been used to argue for third-party payer coverage of DBT screening.

RSNA Introduces VOICE Program

CER is expanding in radiology, particularly as more radiologists recognize its value in answering important questions about the best diagnostic approach to a particular disease or evaluating the cost-effectiveness of procedures they perform or interpret.

To help radiologists better leverage CER in their research, RSNA has launched a new Value of Imaging Through Comparative Effectiveness (VOICE) research training program, which gives radiologists the chance to gain practical research skills.

The VOICE program, which focuses on the core competencies and methodologies most important when performing CER, is led by a multi-institutional team of experienced faculty. Dr. Kang serves as the course director and Pina Sanelli, MD, a radiologist at NYU School of Medicine, serves as co-director.

The program offers a blended approach using web-based videos, webinars and readings, along with hands-on training.

“With the growing emphasis on value, a litmus test for a subspecialty’s condition may be whether its services have an established role in improving patient outcomes,” Dr. Kang said. “We hope that by training more radiologists in these methods and having a larger body of CER and health services researchers, we can help grow the evidence on effective practices and valuable innovations.”