An evaluation of recent federal spending on comparative effectiveness research: priorities, gaps, and next steps.

The American Recovery and Reinvestment Act of 2009 included new funding for developing better evidence about health interventions, with a down payment of $1.1 billion for comparative effectiveness research. Our analysis of funds allocated in the legislation found that nearly 90 percent of the $1.1 billion will eventually be spent on two main types of activity: developing and synthesizing comparative effectiveness evidence, and improving the capacity to conduct comparative effectiveness research. Based on our analysis, priorities for the new funding should include greater emphasis on experimental research; evaluation of reforms at the health system level; identification of effects on subgroups of patients; inclusion of understudied groups of patients; and dissemination of results.

Assessment of the quality of cost analysis literature in physical therapy.

BACKGROUND: Policy makers, payers, and other stakeholders increasingly call for greater evidence of the cost-effectiveness of health care interventions. OBJECTIVE: The purposes of this study were to identify and rate the quality of cost analysis literature in physical therapy and to report summary information on the findings from the reviewed studies. DESIGN: This study was a targeted literature review and rating of relevant studies published in the last decade using a quality evaluation tool for economic studies. MEASUREMENTS: The Quality of Health Economic Studies (QHES) instrument was used to obtain quality scores. RESULTS: Ninety-five in-scope studies were identified and rated using the QHES instrument. The average quality score was 82.2 (SD=15.8), and 81 of the studies received a score of 70 or higher, placing them in the "good" to "excellent" quality range. Investigators in nearly two thirds of the studies found the physical therapy intervention under investigation to be cost-effective. LIMITATIONS: The small number of studies meeting the inclusion criteria was a limitation of the study. CONCLUSIONS: The quality of the literature regarding the cost-effectiveness of physical therapy is very good, although the magnitude of this body of literature is small. Greater awareness of the strengths and limitations of cost analyses in physical therapy should provide guidance for conducting high-quality cost-effectiveness studies as demand increases for demonstrations of the value of physical therapy.