Introduction

The Patient-Centered Outcomes Research Institute (PCORI) was established by the Patient Protection and Affordable Care Act (ACA) of 2010 as a major new center to evaluate and implement clinical comparative effectiveness research (CER). It is a private, non-profit, tax exempt corporation designed to “assist patients, clinicians, purchasers and policy makers in making informed health decisions by advancing the quality and relevance of evidence concerning the manner in which diseases, disorders and other health conditions can effectively and appropriately be prevented, diagnosed, treated, monitored and managed through research and evidence synthesis”.1 2 The ACA's directive is that the institute “shall enter into contracts for the management of funding and conduct of research with government agencies and academic or private sector research entities and that it shall give preference to the Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health (NIH)”.

The ACA established two independent and independently funded boards to control medical costs. The Independent Payment Advisory Board task is to implement target growth rates for Medicare while the PCORI's task is to evaluate and apply CER.1 3–5 The intent underlying the formation of the two panels is that they will, with their commingled effects on what care can be provided and what will be paid, provide high quality care at a reasonable cost.

The supporters of the PCORI and ACA proclaim the advantages of the PCORI and CER.4 6–8 In a 2008 report exploring ways to reduce healthcare costs, the Congressional Budget Office wrote that CER would reduce total spending on healthcare in the USA by an estimated US$8 billion from 2010 to …