New Therapies: And Their Costs

Again the brother of the former White House Chief of Staff writes on health care and how it should be rationed, in his opinion. The discussion this time is on proton beam treatment of prostate cancer. He has a point worth considering but presents a conundrum as well.

In the NY Times he states:

The most promising option is a new approach called dynamic pricing. Medicare would pay more for proton beam therapy, but only for diseases that are proven to be treated more effectively by the therapy than by other forms of radiation. For cancers like prostate, it would pay only what it pays for the cheaper alternatives. But if studies were done showing that proton beam therapy was better than other treatments, the payment would go up. If no studies were done, or the new evidence demonstrated no advantages, then coverage would continue, but at the lower reimbursement.

 Now this is a somewhat rational approach. Namely a new therapy comes along and it is expensive yet unproven clinically. However clinical tests to "prove" its effectiveness would require many years and many patients, depending on the desired end point. For example if death is the end point then one may have to test for say 10 years or more and then look at survival, especially when looking at prostate cancer.

This proposal may hit a brick wall when we start to look at many of the new genetically developed pharmaceuticals treating cancers. These have passed clinical three phase trials where efficacy has been proven but their costs are often monumental and the effectiveness may prolong life but a small amount. Thus will he then deal with these as the Brits, namely the QALY approach, and pay on some similar pari passu basis?

As they say, paraphrasing, the cost we will always have with us.