Comparative Effectiveness
Evidence comparing a therapy's real-world benefit and risk against the available alternatives.
Comparative effectiveness is evidence measuring how a therapy's benefit and risk profile stacks up against the alternatives a patient could realistically be given instead, not just against a placebo. It's a different question than the one a typical registration trial answers, and it usually draws on a mix of head-to-head trial data and real-world evidence.
This is the evidence category payers care about most, because a payer isn't deciding whether a drug works. They're deciding which of several working options to cover, and at what tier. Comparative effectiveness data, together with the budget-impact modeling built on top of it, forms the core of an AMCP dossier submission. Keeping the comparison fair (same patient population, same dosing assumptions, same endpoints) is what makes that data defensible once a payer's own reviewers check it.