Friday, August 8, 2008

Costs and benefits

This item from the Wall Street Journal's health blog caught my eye, because one of the drugs mentioned, sorafenib (Nexavar), is currently in trials for some metastatic sarcomas. The UK's National Health System is denying patients access to several new kidney cancer drugs (including Sutent and Avastin, which are also being tried on sarcomas) because their costs outweigh their benefits. The post explains:

Is extending life by a few months worth $50,000? No, says the UK’s National Institute for Health and Clinical Excellence.
That high price isn’t worth the benefit conferred by the drugs, NICE concluded, and buying the drugs would force the National Health System to deny patients other treatments that are a better bang for the pound. The cost-effectiveness limit for NICE is £30,000 per good-quality year of life gained, the Times says.

The currency conversion is $57,638. A year of good-quality life for less than $60,000. I'd pay more than that, but I find the calculation chilling. (More chilling is that some of the cost-benefit calculations used in the United States -- say for airborne contaminants -- value lives at considerably less.) In most places, the price of high-quality, comprehensive health care is restrictions on treatments that haven't proved their worth over large populations. But what about for you, an individual? There's always the chance of being an outlier on the survival cure; of getting, say, eight extra months instead of the two or three these drugs usually provide. And, as these new agents are approved for more indications, the revenues may fuel additional trials to develop combination therapies that may more meaningfully extend life. 
But take a drug like Erbitux, which can in some contexts provide six additional weeks of median survival, with uncertain quality of life, for $62,000. Is that a good deal? How about three weeks? I recall it being reported at the ASCO meetings that Erbitux, which happens to be the drug Martha Stewart got in trouble for insider trading on, was approved for a lung-cancer indication because it increased survival by a median of less than a month. 

Is that hope or madness?

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