Comparative-effectiveness is a cornerstone in President Obama’s vision of health reform, and is a component of the ARRA stimulus package. But if it’s just about a pill-to-pill comparison, it won’t do Americans’ public health much good.

In an insightful perspective in the July 23rd 2009 issue of the New England Journal of Medicine, Dr. Kevin Volpp and Anup Das of the University of Pennsylvania urge us to, “think beyond Medication A versus Medication B.”

Diving deep into the example of smoking cessation – still a major public health challenge in the U.S. – the researchers compare the odds ratios of various quit-smoking strategies, from patches to gums to oral meds, as illustrated in the chart.

Volpp and Das point out that it’s not just the drug therapy that gets people to stop smoking: it’s also behavioral approaches that get people to adopt healthier lifestyles. Volpp and Das found, for example, that financial incentives for smoking cessation are very effective — tripling smoking-cessation rates at 9 to 12 months and resulting in quit rates that are 2.6x those achieved with a control treatment.

Health Populi’s Hot Points: As we read the latest health economics data point today that obesity generates 9.1% of health spending in the United States, Volpp and Das’s research reminds us that getting-to-health is achieved through more than hope-in-a-pill, a device, or procedure. People-patients are at the center of the health system, and their health behaviors can make – or break – the health system’s investment in therapies and services. This is more evidence on the power and importance of The Nudge.

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