Comparative effectiveness research in public health: Background and overview

In clinical settings comparative effectiveness research (CER) compares the effectiveness of two or more treatments for a certain medical condition for a particular set of patients. CER also is implemented in public health to compare the effectiveness of two or more prevention or health promotion interventions to determine which interventions yield the most benefit in which populations.

We will provide background on CER, outline the rationale for implementing CER in public health, and introduce four examples of public health CER.

A new role for CER is being carved out in public health. The effectiveness of particular interventions may depend on the settings in which they are applied (e.g., minority communities, tribal clinics), and CER can help identify the characteristics essential to success in specific communities and settings. The focus can also be on dissemination of public health interventions, policy changes, or environmental changes that promote healthy behaviors or reduce behaviors that increase risk of disease or disability. The long-term goal is to translate the most effective public health interventions or strategies into public health programs, practice, and policy in communities throughout the country in a time- and cost-efficient manner.

Public health CER to prevent chronic diseases and promote health can contribute to reducing health disparities, increasing scientific knowledge, and reducing health care costs. As the nation moves to reduce health care costs and institute evidence-based, cost-effective public health programs, knowing which of several interventions or strategies are best in preventing disease and disability and promoting health is essential.