What’s a year of life worth?

New paper out in Health Affairs, “In A Survey, Marked Inconsistency In How Oncologists Judged Value Of High-Cost Cancer Drugs In Relation To Gains In Survival“:

Amid calls for physicians to become better stewards of the nation’s health care resources, it is important to gain insight into how physicians think about the cost-effectiveness of new treatments. Expensive new cancer treatments that can extend life raise questions about whether physicians are prepared to make “value for money” trade-offs when treating patients. We asked oncologists in the United States and Canada how much benefit, in additional months of life expectancy, a new drug would need to provide to justify its cost and warrant its use in an individual patient. The majority of oncologists agreed that a new cancer treatment that might add a year to a patient’s life would be worthwhile if the cost was less than $100,000. But when given a hypothetical case of an individual patient to review, the oncologists also endorsed a hypothetical drug whose cost might be as high as $250,000 per life-year gained. The results show that oncologists are not consistent in deciding how many months an expensive new therapy should extend a person’s life before the cost of therapy is justified. Moreover, the benefit that oncologists demand from new treatments in terms of length of survival does not necessarily increase according to the price of the treatment. The findings suggest that policy makers should find ways to improve how physicians are educated on the use of cost-effectiveness information and to influence physician decision making through clinical guidelines that incorporate cost-effectiveness information.

I don’t want to spend a lot of time on the methods, because this pretty much tells you all you need to know. When asked, most oncologists thought that a drug should cost less than $100,000 per year of life gained to be cost-effective. When confronted with a patient (even a hypothetical one), however, they endorsed giving drugs that cost up to $250,000 per additional year of life.

The authors conclude that we should do a better job of helping doctors understand how cost-effectiveness information should be used. I agree with that, but want to add to it. It’s necessary, but not sufficient.

I think society needs to have this discussion. Almost no one has $250,000, or even $100,000, saved up if they need it to extend their life for one year. So when we say we think that’s the reasonable number, we’re asking others to pay for it, either through government programs or private insurance. Is $100,000 a reasonable amount to pay for an additional year of life? Is it too low? Is $250,000 enough?

There has to be a maximum. Surely $1 trillion is too much for a year of life; that would bankrupt the country. So there is a limit, and this isn’t a theoretical exercise. It’s something we really need to decide at some point. But it’s a conversation America seems determined never to have.


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