Wednesday, September 22, 2010

NEJM: Good Study Result; But A Poor Value Proposition -- For A Marginal Problem

Increasingly here (as has long been the case in EU countries), United States journals are explicitly highlighting the cost v. benefit of new drugs -- even when the study results are overwhelmingly positive. Tonight, it is an editorial in the prestigious New England Journal of Medicine -- looking askance at a study it published in the very same issue. The drug is Arixtra®, the maker is GlaxoSmithKline, and here is the New York Times' Duff Wilson -- covering it all -- do go read his:

. . . .But the study did not talk about the costs, they wrote, which could range from $2,124 to $7,380 per person for 45 days of injections, or at least $186,000 for 88 people to avoid one new problem.

“The paradox is, it’s effective, but for a condition that’s usually not considered an overwhelmingly serious medical problem,” Dr. Goldman said in an interview. “The fact that it’s a medicine that’s expensive really raises an issue, not just for this trial, but we tried to make the point more broadly.”

Cost-effectiveness researchers in America have benchmarks that suggest that “good value for the money” is $50,000 per added year of high-quality life, Dr. Resch said. In some cases, where cheaper treatments are unavailable, up to $120,000 per added year have been suggested, he said. . . .

Plainly, this is a discussion we really should be having about all drugs -- not just the newest ones (think Merck's Vytorin®, here).


Anonymous said...

Just for debating purposes: Isn't this a 'death panel' pathway?

Condor said...

Just responding, then:

Um. . . non-life threatening condition; expensive treatment?

Nope. No death possible -- except to our wallets.

The more general point -- as to cost v. benefit (in truly life v. death calls) -- will always raise that difficult question, though.

Just because it is a difficult question, however, we are not exempt from being required to think it through, right?


Anonymous said...

I'd love to continue this exercise.

What 'someone' now is proposing that my access to medical care needs to be overseen by a committee/panel that will determine if my quality of life meets their fiscal priorities.

As mentioned over on Pharmalot:

"HervĂ© Decousushe tells the Times, noting that clots can be seen expaning in the veins under skin toward deeper veins where they can also migrate to the lungs. “It’s painful, and you can see the clot in front of you…We don’t want to wait for a fatal pulmonary embolism.”
Last I knew, fatal=death.

Slippery slope to 'death panels.'

BTW: this is just an exercise.

What I believe is that we do have to have these conversations on; exactly what are we (as a nation) willing to pay for and what we aren't. Knowing full well, that the lines for that will change.

Thanks for the exchange.

Condor said...

Yes, this is a nice exchange -- civil and easy.

And, near as I can tell (for the sake of argument) no one is suggesting these superficial topical clots are (by themselves) life-threatening.

Is $288,000 per each potential new event avoided too high, when the even (while painful) is considered not life-threatening?

I don't know. But like you, I think it is the sort of hard discussion we ought to have, openly -- rather than simply letting the savage allocation of excessive wealth v. poverty force that allocation indiscriminately -- if we are after a more humane system, overall.