RSNA 2019: Comparative effectiveness research comes into its own
In U.S. healthcare’s volume-to-value era, the ability to directly compare two or more diagnostic and/or therapeutic options is paramount. And the head-to-head matchup must reveal which pathway promises the biggest bang for the buck.
Enter comparative effectiveness research, or CER, which allows investigators to weigh the differences—financial as well as clinical—of feasible strategies for preventing, diagnosing, treating and tracking disease in real-world clinical settings.
Two experts in the field supplied a primer on the burgeoning research branch Dec. 3 at RSNA in Chicago. In doing so, they also introduced RSNA’s VOICE program, which the organization began administering earlier this year, following its initial launch with NIH funding around two year ago.
VOICE stands for value of imaging through comparative effectiveness. More than 50 radiology researchers completed the earlier NIH iteration. Around 20 are in the current cycle under RSNA’s custodianship, actively working on projects.
Broadly applicable
The VOICE program is a training curriculum open to “anyone who’s interested in gaining some new skills in this area of comparative effectiveness research,” explained course director Stella Kang, MD, of NYU Langone Health. “In radiology, we’ve been a little bit behind [other medical specialties] in this area.”
Comparative effectiveness research is “a great deal to get into for research,” added co-director Pina Sanelli, MD, of Northwell Health, in New York. CER allows “a clinical radiologist to target questions in research that we ask every day as we’re working in our reading rooms.”
Sanelli, a neuroimaging expert who is a professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, said CER is especially effective for answering questions that may seem simple but, in fact, have broad ramifications.
In a nutshell, CER is very much centered on outcomes, she said.
“Essentially what we’re doing is looking at two different imaging strategies. We compare their effectiveness [as revealed in] the outcomes,” Sanelli said. “And these outcomes may be patient outcomes, they may be quality-adjusted life years, they could be cost outcomes.”
Or they could be all of the above, she suggested.
Reimbursement ramifications
To this Kang added that CER is especially well-suited to the volume-to-value era.
“We’ve had an onslaught of reimbursement cuts and policies really sort of cutting back on how radiology and imaging at large are viewed in terms of contribution to overall care,” Kang said. “The special thing about cost effectiveness analysis is that it combines the patient outcomes and the costs into one metric. And that’s a method of comparative effectiveness research.”
Radiology needs to be able to offer head-to-head comparisons whose results can be readily shown and easily understood, Kang noted.
“If we’re talking about drugs, other health interventions, procedures and tests, there has to be a way of conducting apples-to-apples comparisons,” she said. “If we don’t have those metrics in the same way that other medical specialties do, we’re behind in the game and we’re losing our seat at the table.”
It goes without saying that radiology is constantly seeking better ways to detect disease earlier, laying the groundwork for earlier clinical treatments and better overall outcomes.
“But if we don’t do this type of research to show the value in the service that we as radiologists provide,” Sanelli said, “it will be very difficult for radiologists to maintain any type of reimbursement structure.”
Kang pointed out that policymakers use these kinds of studies to consider how payers, patients and other stakeholders are thinking about value.
“Everyone is trying to make the most of the dollars being put into healthcare right now,” she said. “Having these metrics in studies that can go up against studies in other fields of medicine—fields that are fighting for the same resources as we are—is really key.”
RSNA in the game
Pivoting to the RSNA VOICE program for learning CER, Kang said it’s designed for busy clinical radiologists.
The program includes two workshops and several web modules, and it’s broken into three courses covering subjects such as evidence synthesis, decision analysis using Markov computer modeling and cost-effectiveness analysis.
VOICE offers a chance for researchers at all levels to begin building a portfolio in CER, mainly through learning new skills and trying to apply them to a project idea, Kang said.
The program is accessible for any faculty at any career stage, she added.
RSNA’s VOICE program “really encompasses all levels of research training,” said Sanelli. “Even if there are medical students who are interested, they can also learn more about this type of research. Because again I’d like to emphasize that this is the type of research that’s going to answer the question that you may have every day in the reading room when you’re trying to sort out what seem to be simple questions.”
“Today it’s incredibly important to measure value,” Sanelli said. “And value is a term that we use loosely. But when we talk about clinical effectiveness and cost-effectiveness research, value is defined as health benefits per dollars.
“When you can show the value of what you do as a radiologist—the health benefits that you provide per dollars—that’s incredibly important in the health policy space.”
For more on the program, click here.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.