How Much Is Too Much For Your Life?
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Posted to SciTech on Thu Mar 27, 2008 at 02:54:11 AM EST (promoted by 1fastdog). RSS.
The American Society for Clinical Oncology is preparing new guidelines for treatment which will, for the first time, include a discussion of cost considerations for advanced treatment options. The lack of universal health care in the US, combined with skyrocketing costs, has pushed this issue to the forefront for patients facing a terminal cancer diagnosis.
According to the article:
The prices can be staggering. Consider: There are two equally effective options to battle metastatic colon cancer, the kind spreading through the body -- but one costs $60,000 more than the other, says Dr. Leonard Saltz of Memorial Sloan-Kettering Cancer Center.Of course, this problem is not just limited to the US. Many countries with universal healthcare systems must also face similar problems, as cash strapped programs must decide whether it makes sense to pay for drugs that may extend one person's life for a few weeks with a cash outlay that would pay for cheaper and slightly less effective drugs for a hundred people at the same cost.What's the difference? The cheaper one, irinotecan, causes hair loss that makes it impossible for people trying to keep a job to hide their cancer treatment, he explains. The pricier oxaliplatin can cause nerve damage in hands and feet that might make it a worse option for, say, a musician or computer worker.
Saltz offers a tougher example: A drug for pancreatic cancer -- an especially deadly cancer with few treatment options -- can cost $4,000 a month. Yet while Tarceva has offered some people remarkable help, research suggests that extra survival on average is a few weeks.
"Is it a good investment, a high-risk investment, or buying a lottery ticket?" is how Saltz puts these choices.
Some Americans on public assistance have already seen this sort of bureaucratic rationing - the article notes that:
When Medicare began its Part D prescription coverage, retiree Helen Geiger of Whiting, N.J., paid for a premium plan and put it to good use when she was diagnosed with multiple myeloma, a blood cancer. She said the plan listed the cost of her dose of Thalomid at $5,500 a month but her copay was $60 a month.Given the fundamental questions of fairness involved (should accumulated wealth really be what defines the length of a person's life? Should disconnected bureaucrats really be making life or death decisions based on actuarial tables?), is there any good way to resolve this dilemma? The number of life prolonging treatments (and their associated cost) will no doubt increase exponentially in the coming decades, making this a problem that seems unlikely to simply fade away.In renewing the prescription plan last year, the 71-year-old Geiger didn't notice that Thalomid coverage had been changed. It now was classified a specialty drug, costing a $1,051 monthly copay that she couldn't afford.
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