Comparative effectiveness research — the missing link in evidence-informed clinical medicine and health care policy making

To change practice, we should move beyond trial-based efficacy to real-world effectiveness

Meaningful health care reform requires robust evidence about which interventions work best for whom and under what circumstances. The Institute of Medicine in the United States has estimated that less than 50% of current treatments are supported by evidence and 30% of health care expenditure reflects care that is of uncertain value.1 In studies testing established clinical standards of care, more than half reported evidence that contradicts standard care or is inconclusive.2 Many Medicare Benefits Schedule services lack comprehensive evidence of comparative safety or effectiveness, while many that have been evaluated have been shown to be ineffective, harmful or of uncertain value compared with alternative forms of care.3