We have all heard about
cancer treatments
that cost $100,000 or more, but only yield an average survival of a
couple of months. Is it worth it, you may have wondered, especially
when there are so many other healthcare treatments that produce longer
survivals and, perhaps, better quality of life?
The answer, of course, depends on who you are. If you are the young, healthy Chief
Medical
Officer of a Health Plan, responsible for making decisions about how
precious resources are spent, you may not value a very expensive cancer
treatment with a short median survival time as highly as a less
expensive treatment for another disease that has more impressive
survival statistics. However, if you are a young mother with metastatic
breast cancer, it is likely that the value calculation is quite
different.
If you now factor in the difference between the average
survival and the spread of survival related to any given treatment, the
calculation changes yet again. As a patient with an advanced cancer,
you may not want to spend $100,000 on a treatment if you knew for sure
that
your survival was only going to be three months, but what
if there was a 15% chance that the same treatment could give you an
additional twenty months of life?
In an effort to shed light on this issue,
Darius Lakdawalla (Director
of Research at the Leonard D. Schaeffer Center for Health Policy and
Economics, USC) and colleagues designed an interesting study that was
published in the
April 2012 issue of Health Affairs.
The empirical question was “Do patients near the end of life like or
dislike therapies with greater spread in survival outcomes?” In other
words, “would patients value the ‘hope’ of a large survival gain,
independent of a therapy’s average gain.”
Darius Lakdawalla, Dir. Research, USC
To
answer the question, the researchers presented different scenarios to
cancer patients and asked them to choose which treatment they preferred
and how much they would be willing to pay for it. There were two
scenarios, one that described options for treatment of metastatic breast
cancer and the other treatment for advanced melanoma. The treatments
presented to the patients were “real-world” therapies based on the
published clinical trials.
The metastatic breast cancer treatment
“hopeful” scenario was based on a recent clinical trial in which
combination therapy, ixabepilone (Ixempra) plus capecitabine (Xeloda),
produced a median survival of 12.9 months, but a one in ten chance of
living past forty-eight months. It was compared to a hypothetical
treatment that they were told would produce, with 100% certainty, an
eighteen month survival – a “sure bet.”
for more,
http://healthworkscollective.com/psalber/31660/what-value-hope-cancer-care?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+healthworkscollective_allposts+%28Healthworks+Collective%29
