Cost is preventing cancer patients in both the US and Britain from receiving certain cancer drugs. There are striking parallels between yesterday’s post on the price of cancer drug Avastin and its impact on patients and an article in today’s NYTimes on the decision by Britian’s National Health Service to deny Herceptin (free subscription required) to women with early stage breast cancer.
In both cases, the decision by payers to not cover the full cost of the drugs is based in part on a lack of clinical evidence. Only in part. The other basis for the decision is clearly cost related. Britian’s NHS is under very heavy pressure to keep costs under control. This pressure has come up against patient advocacy groups and physicians who want to be able to treat as they see fit. Eerily similar to the situation on this side of the Atlantic, where patients find themselves unable to afford drugs that their physicians think will help them battle cancer.
The tendency is to personalize the problem by focusing on one patient. While there are individually painful stories, they take away from a very important, albeit painful, discussion that both Britain and the US must have about cost, benefits, and opportunity cost.
The patient profiled in the Times lives in an area administered by the Swindon Primary Care Trust. The Trust is looking at the cost of paying for Herceptin for 20 potential recipients of the drug, balanced against the needs of all 200,000 residents they have to provide care for under a finite budget. There are 20 women with early stage breast cancer that theoretically might benefit from Herceptin; at a cost of $40,000 each, that’s $8 million annually.
For all those that decry the British health system’s inherent rationing of health care, I would ask if it is “better” to spend that $8 million on a drug without proven efficacy for that specific condition for 20 patients, or use it to provide pre-natal care to prevent low birth weight babies; fund an anti-smoking program to reduce future cancers; or perhaps buy vaccines and treatments for the bird flu that is just off Britain’s shores.
Anyone for playing God?
Feb
16
