An Evidence-Based Approach to Covid-19 Vaccination

Abstract

Title VIII of the American Recovery and Rein- vestment Act of 2009 authorizes the expenditure of $1.1 billion to conduct research comparing “clinical outcomes, effectiveness, and appropri- ateness of items, services, and procedures that are used to prevent, diagnose, or treat diseases, dis- orders, and other health conditions.” Federal support of “comparative effectiveness” research has been viewed as a cornerstone in controlling runaway health care costs. Although cost is not mentioned explicitly in the comparative effectiveness legislation, the American College of Physicians and others have called for cost-effectiveness analysis — assess- ment of the added improvement in health out- comes relative to cost — to be on the agenda for comparative effectiveness research.1,2 This ap- proach has come under harsh criticism from some who view it as the first step in health care rationing by the government — that cost cutting will mean the withdrawal of expensive treatments with small (but still positive) benefits. Some poli- ticians have therefore tried to restrict any efforts to use comparative effectiveness to guide U.S. health care policy.3