End Of Life Medical Spending: Choices, Choices

TW: End of life medical spending is a controversial topic. Few wish to hasten the end for themselves or loved ones. End of life medical spending is a disproportionate piece of total health care spending. To address total spending requires facing up to those challenging practical and ethical questions of end of life spending.

The topic appears superficially distasteful but in substance is not necessarily so. One knows spending a $1 billion to extend life by a day is non-sensical. But what about $1,000 to extend a day? Multiply $1,000/day X 1,000 people X 100 days and you get to the same $1 billion. Is that viable/desirable? What about that $1 billion being deployed instead on pre-natal care to increase the likelihood for healthier live births for say 1 million mothers ($1,000/mother)? Which makes more sense?

Cutting edge but highly costly treatments will present providers and funders with increasingly challenging decisions.

Resources are finite, choices must be made.

From Mark Thoma's blog:
"How much is life worth? The $440 billion question, EurekAlert: The decision to use expensive cancer therapies that typically produce only a relatively short extension of survival is a serious ethical dilemma in the U.S. that needs to be addressed by the oncology community...cost-benefit relationships for several cancer drugs, including cetuximab for treatment of non-small cell lung cancer, touted as "practice changing" and new standards of care by professional societies, including the American Society of Clinical Oncology. ...

... 18 weeks of cetuximab treatment for non-small cell lung cancer, which was found to extend life by 1.2 months, costs an average of $80,000, which translates into an expenditure of $800,000 to prolong the life of one patient by 1 year. At this rate, it would cost $440 billion annually ... to extend the lives of 550,000 Americans who die of cancer annually by 1 year.

To address the issue, the commentators recommend that studies powered to detect a survival advantage of two months or less should test only interventions that can be marketed at a cost of less than $20,000 for a course of treatment.

Every life is of infinite value, the authors say, but spiraling costs of cancer care makes this dilemma inescapable.

"The current situation cannot continue. We cannot ignore the cumulative costs of the tests and treatments we recommend and prescribe. As the agents of change, professional societies, including their academic and practicing oncologist members, must lead the way," the authors write. "The time to start is now."
http://economistsview.typepad.com/economistsview/2009/06/an-ethical-dilemma-in-end-of-life-care.html