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, 88 (2), 256-76

EBM, HTA, and CER: Clearing the Confusion


EBM, HTA, and CER: Clearing the Confusion

Bryan R Luce et al. Milbank Q.


Context: The terms evidence-based medicine (EBM), health technology assessment (HTA), comparative effectiveness research (CER), and other related terms lack clarity and so could lead to miscommunication, confusion, and poor decision making. The objective of this article is to clarify their definitions and the relationships among key terms and concepts.

Methods: This article used the relevant methods and policy literature as well as the websites of organizations engaged in evidence-based activities to develop a framework to explain the relationships among the terms EBM, HTA, and CER.

Findings: This article proposes an organizing framework and presents a graphic demonstrating the differences and relationships among these terms and concepts.

Conclusions: More specific terminology and concepts are necessary for an informed and clear public policy debate. They are even more important to inform decision making at all levels and to engender more accountability by the organizations and individuals responsible for these decisions.


Figure 1
Figure 1
Current Confusion over Views of EBM, CER, and HTA.
Figure 2
Figure 2
Redefined Relationships of Evidence Processes. Notes:RCT= randomized controlled trial CER= comparative effectiveness research PCT= pragmatic clinical trial HTA= health technology assessment SRT= systematic review of trials EBM= evidence-based medicine SRE= systematic review of evidence CED= coverage with evidence development Solid lines indicate clear relationships, and dotted lines indicate disputed relationships. Diamonds represent decision processes, and circles and ovals represent all other evidence activities, except for the rectangles, which are reserved for EBM, HTA, and CER.

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