Patients and Doctors Need Skin in the Game for Appropriate Care
A new Seattle Genetics cancer drug (Adcetris) will cost $121,000 for a course of treatment to treat Hodgkin's lymphoma. A new prostate cancer vaccine, Provenge, will cost $93,000. When the FDA approves new drugs, they do not look at cost or cost/benefit ratios. Most of the new drugs approved by the FDA offer marginal improvement over what is already available. The same is true for new medical devices (artificial joints, heart valves, robotics, and new scanners).
Is it worth $121,000 to live an extra 3 months? What about an extra 6 months? What about living an extra 6 months but spending most of that time in the hospital with serious complications? If the hospital down the street has a new $10 million dollar MRI scanner, to be competitive every other hospital has to buy one. Does that raise the standard of health in society? No, but it certainly drives up the cost of care for everyone.
None of these are easy questions and there are no easy answers. What is "appropriate care" and who should be responsible for making cost-effective decisions? On one hand we are seeing a Nationwide shortage of common drugs that are widely used because they are generic and the profit margin has disappeared for the pharmaceutical manufacturers. (I wrote about this a year ago!) The number of drug shortages has tripled since 2005. A common cancer drug, Doxil, cannot be found and similar shortages of common antibiotics and anesthesia drugs are in short supply. This is happening at the same time as the new $121,000 cancer drug is announced.
Make no mistake, we do have a fixed health care budget. The Medicare bank is broken and the wave of baby boomers hitting Medicare age is just beginning. Tough as it is, we need to develop policies that will allow everyone to live long and healthy. We need to look out for the common good and society as a whole. Determining appropriate care, based on our best science and evidence is a critical first step.
Patients and Doctors need to tackle this one together and neither patients nor physicians have the luxury any longer of having unlimited health care resources without the responsibility of who will pay for it.