Saturday, September 02, 2006

Revisiting The High Cost of End-of-Life Care

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.


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