Comparative effectiveness research is the generation of evidence that compares the benefits and harms of alternative methods to prevent or manage a clinical condition or improve the delivery of care (CER). In 2008 the Institute of Medicine issued a report calling for research that would support better decision making about innovations in healthcare. In Feb 2009 President Obama signed into law an initial $1 billion to support research on the comparative effectiveness of drugs, medical devices, surgical procedures and other treatments. CER has the potential to improve care and reduce costs. The objective is to advise on health care both at an individual and population level. It helps by reducing overuse, underuse and misuse of therapies and technology. CER has the potential to identify the most effective interventions and to significantly improve health outcomes. In order to drive the process the Patient-Centred Outcomes Research Institute (PCORI) has been established in the US1. It has a budget of half a billion dollars a year to spend on research and information dissemination.