We’ve mentioned in previous posts that comparative effectiveness research (research that directly compares the effectiveness of different treatments for the same illness) received funding in the stimulus bill, and that the Institute of Medicine was gathering public input in order to inform a report providing specific recommendations to Congress for prioritizing the expenditure of the funds. On Tuesday, the IOM released that report, “Initial National Priorities for Comparative Effectiveness Research“, which includes a list of 100 top topics (out of 1,268 unique suggestions) that the authoring committee believes should be prioritized for funding.
The committee writes that the list of priorities was determined not just by which conditions affect the largest number of people, but with balance in mind. The full report notes that rare diseases and conditions that disproportionately affect specific segments of the population were also considered. They also explain that while comparative effectiveness research often focuses on comparing drug A to drug B, the committee felt it was important to include a diversity of interventions and different types of therapies, and they also considered where the gaps are in existing research.
The priority list includes several childbirth related topics, including this: “Compare the effectiveness of birthing care in freestanding birth centers and usual care of childbearing women at low and moderate risk.” The report doesn’t specify what “usual care” is, so we can only assume that it means birth in a hospital with an ob/gyn. The list also doesn’t include details on how the effectiveness of birthing care will be judged, but we’ll certainly keep an eye out for more information!
Several other topics that are at least partially specific to women’s health made it into the top 25 priorities (the list of 100 was further broken down into quartiles). They include:
- Genetic and biomarker testing and usual care in preventing and treating breast, colorectal, prostate, lung, and ovarian cancer, and possibly other clinical conditions for which promising biomarkers exist.
- Interventions to reduce health disparities in cardiovascular disease, diabetes, cancer, musculoskeletal diseases, and birth outcomes.
- Clinical interventions (e.g., prenatal care, nutritional counseling, smoking cessation, substance abuse treatment, and combinations of these interventions) to reduce incidences of infant mortality, pre-term births, and low birth rates, especially among African American women.
- Innovative strategies for preventing unintended pregnancies (e.g., over-the-counter access to oral contraceptives or other hormonal methods, expanding access to long-acting methods for young women, providing contraceptive methods at public clinics, pharmacies, or other locations).
Other relevant topics include comparison of weight-bearing exercises and bisphosophonates for preventing fractures in older women with osteoporosis, film screen or digital mammography and mammography plus MRI for breast cancer screening in high risk women, outcomes with and without the use of obstetric ultrasound in normal pregnancies, and “strategies for promoting breastfeeding among low-income African American women.”