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Americans must consider cost and effectiveness when comparing and choosing medical interventions

Washington, May 15, 2008 The American College of Physicians (ACP) proposed today a means to improve physician and patient access to and use of information about clinical and cost-effectiveness when comparing medical products, procedures and services.

The recommendations are featured in an article, Cost-Effectiveness Information: An Essential Feature of a National Comparative Effectiveness Entity, published online today in Annals of Internal Medicine, ACPs flagship peer reviewed journal ( The Annals article is based on a broader comparative-effectiveness policy paper also released today online at The article addresses how costs and clinical outcomes are interrelated, and has a major impact on physician practice and patient care in the U.S.

The article looks at how U.S. attitudes about cost-effectiveness has failed to produce an adequate supply of reliable information about what health care works best for a patient in specific clinical situations and with a limited budget. ACP recommended that the U.S. establish a trusted, independent, adequately-funded national research organization to fill the gap.

The proposed new entity would develop and disseminate evidence based on comparative clinical effectiveness and cost-effectiveness in health care. Further, it would educate the public about the urgency of modifying what it has found to be an American cultural bias toward downplaying the cost of health care--especially when payment seemingly comes from a health insurer or other third party payer rather than from patients own pockets.

The new ACP study encourages doctors and patients to use comparative-effectiveness information as a route to containing health care costs, noted David M. Dale, MD, FACP and president of ACP. We very much support the creation of this new entity. And emphasize the importance of this proposed entity to produce both comparative clinical and cost-effective information.

The article also says that because of factors including:

  • the explosion of health care costs;
  • the de facto rationing produced from 47-million uninsured patients denied access to health care; and
  • the limited resources of the American society,

The time has come for patients, physicians, insurers and health policymakers to factor into their decisions explicitly and transparently the comparative clinical effectiveness, the comparative cost and the cost-effectiveness of new and existing health care interventions.

The article and new ACP policy paper particularly address the reluctance in American society to produce and consider cost information in evaluating the value of various clinical products, procedures and services, and how this reluctance adversely affects ensuring the availability of health care for all.

The article recognizes that because of the finite resources available for heath care costs must be a factor, but that differences in costs should never be considered without also considering differences in clinical health outcomes explicitly and transparently.

The economic impacts of interventions should be used in decision making along with evidence of clinical effectiveness, Dr. Dale concluded, but the public and clinicians will only trust such information if it comes from an independent research source that does not itself have an economic conflict of interest in the results of its analyses.


Contact: David Kinsman
American College of Physicians

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