What is the Value of Hope in Cancer Care? from HealthWorks Collective

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

Court’s Potential to Goad Voters Swings to Democrats

The prospect arises both because of President Obama’s comments this week implicitly warning the court against striking down his signature domestic achievement, the expanded health insurance law, and because of recent court rulings, chiefly the Citizens United campaign finance decision, and looming cases on immigration and affirmative action that incite passions on the left.

“Historically, the court has been a rallying point for the Republican base, and it is now much easier to imagine that it will be a rallying point with the Democratic base just as much if not more, especially if the court overturns the Affordable Care Act,” said Geoff Garin, a Democratic pollster who works with Priorities USA Action, a group supporting the president’s re-election but independent of his campaign.

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1http://www.nytimes.com/2012/04/05/us/politics/this-election-supreme-court-could-rally-democrats.html?_r=1

Bloomberg And Allen Boost Their Health Giving

A couple of really rich guys have decided to give even more money to health causes they care about deeply.
New York Mayor, media magnate and public health zealot Michael Bloomberg said he will give $220 million to fight smoking in the developing world. Bloomberg's charitable foundation has targeted tobacco use.
And the latest chunk of money, which is part of a four-year commitment, will bring Bloomberg Philanthropies' support of anti-smoking efforts around the globe to more than $600 million.
"It is a scourge, all over the world," Bloomberg said in a press conference, according to Bloomberg News. "Smoking kills the user, but it also can kill the people who are innocent and just happen to be in the neighborhood, if you will."

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