Testimony on Comparative Effectiveness Research

Delivered Via Electronic Mail

To whom it may concern:

As someone who is very active in the study of colorectal cancer screening tests, I want to express my enthusiasm for the comparative effectiveness program to be funded by AHRQ. Effective screening tests such as the fecal immunochemical test have been available for use in this country for over a decade but, because of lack of enthusiasm for funding anything but colonoscopy and fecal DNA studies, they have languished unused and unappreciated until recently when they were formerly recommended in two national screening guidelines the American Cancer Society, United States Multisociety Taskforce and American College of Radiology Guidelines published in March, 2008 and the United States Preventive Services Guidelines published in November of 2008. Before 2003 when CMS approved Medicare funding for the fecal immunochemical test (FIT), there was only one FIT available in the U.S. InSure manufactured by Enterix Corporation. Since CMS endorsement there are at least 15 available most of which have never been tested in large average risk populations. Furthermore; issues around number of tests necessary for best sensitivity and specificity, method of stool collection and development, and quantitative vs. qualitative FITs are yet to be resolved. This kind of situation is ideal for the use of the new funds for comparative research and would greatly help our decisions about which FITs are best for use in our communities.

Thanks for the opportunity to comment and good luck on your upcoming meeting

James E. Allison MD
Clinical Professor of Medicine Emeritus UCSF Division of Gastroenterology SFGH
Adjunct Investigator
Kaiser Division of Research