Almost six months ago I wrote about the exorbitant cost of certain life-saving drugs. At the time I argued that, in cases where a high-priced drug might extend a patient's life by a matter of some months, it might be rational to forgo treatments that came packaged with near bankruptcy as a side effect
Six months later my opinion hasn't changed. And, as the Washington Post reports, there are others - actual cancer patients, not armchair bloggers - who are coming to the same conclusion: some drugs just aren't worth the price tag
. While Americans as a group remain increasingly inclined to ignore the price tag when it comes to end-of-life expenses, it appears that the tide is starting to shift ever so slightly:
Despite official denials, the federal Medicare program makes subtle cost evaluations, says Dr. William Maisel, a Boston heart specialist who chairs a federal committee on cardiac devices. "I think they are concerned about people using the term `rationing' or `withholding therapies,'" says Maisel, at Beth Israel Deaconess Medical Center.
One way to control costs, without saying "no," is to keep reimbursements low. For example, Medicare's $140,000 reimbursement last year for heart pumps is widely acknowledged as below-market.
"We can't say, `No,' explicitly. We say, `Yes, but,'" explains Peter Neumann, who runs a Tufts University center on medical cost-effectiveness in Boston.
Yes, but start with a cheaper drug, get prior authorization, or make a bigger co-payment.
Cost-benefit analyses that include the value of individual human lives are a reality in the world today. It should be only a matter of time, one would think, before similar analyses find their way to end-of-life care as well.