A Difficult Choice: Rationing or a Rational Decision

Cancer Research UK relates the tale of the refusal of the National Health System to pay for a cancer drug which has been shown to be effective against primary liver cancer and kidney cancer. The bottom line is the drug costs $4500 per month and extends life 4 months. That is $18000 for the life extension.

The article states:

"Firstly, this treatment is expensive. Although the drug’s manufacturer (Bayer) have offered the NHS a ‘buy three get one free’ deal, they are unable (or unwilling) to lower the drug’s price to a level that the NICE appraisal committee feels able to accept. Bayer’s efforts to lower the price to about £3,000 per month still do not bring it within NICE’s limits of what it regards as an acceptable use of taxpayers’ money. NICE have talked about the other treatments that the NHS could buy for its money. And, to an extent, they have a point...But as our chief clinician Professor Peter Johnson pointed out on BBC’s Today programme this morning, sorafenib works. Most patients with advanced liver cancer can’t be operated on – and surgery is the only treatment that can cure the disease. For people for whom surgery is not a suitable option, there are no alternative treatments – and average survival is about eight months as a result. Clinical studiesshown that sorafenib can extend people’s lives for an extra four months on average. And as part of the appraisal process, NICE heard from doctors who have experience of using this drug and who have seen in practice the benefit that it can give."

This is a difficult ethical choice. The Brits do their analysis with QALYs and this using their analysis just falls outside the bounds. Is 4 months of life worth $18000? Should we even ask that question? What if the patient or their family were to pay half, one quarter, three quarters? Is there any middle ground? We have discussed before the position of those in the current Administration based upon their own words, and those words imply that they would not pay, not a penny.

This is also akin to the current breast cancer debate. Frankly there is no simple answer here. Life has value, yet four months, with significant discomfort may or may not be valuable, to the person to whom it matters, the patient. This question posed here is worth discussing, and not creating a health care system which prohibits its discussion.