On Access to Life-Saving Treatments
Last week, the CEO of the Cleveland Clinic – which President Obama famously visited last year to tout as a model of health reform – worried about the impact of comparative effectiveness research on patients’ access to treatments. As a Cleveland Plain Dealer article notes, Dr. Cosgrove stated his concern that “if we only pay for one of those [treatments], we begin to limit what people are willing to do in terms of developing new products.” He went on to explain the lengthy – and costly – process needed to approve new drugs and treatments, and asked the question of whether investors will want to keep funding research projects for new therapies not knowing whether or not a government board will eventually approve those therapies as “effective.”
While Dr. Cosgrove stated his concerns that comparative effectiveness research – even research that does not consider the cost of treatment options – could hinder life sciences research, an article in the August edition of Health Affairs (subscription required) goes in the opposite direction, evaluating the costs of improving mortality levels for certain diseases in order to derive health care “value.” This study, which examined trends in hospital mortality and costs for several common diseases, included the following noteworthy conclusion:
For all diagnoses, the oldest patients experienced the lowest cost per life saved because they had the largest mortality reductions and the smallest cost increases. However, younger patients usually live longer when mortality is averted. For this reason, cost per life-year saved is a better measure of cost-effectiveness.
The article’s emphasis on achieving greater value in health care, coupled with talk of “the relative value of different therapies that might not be applied equally to all age groups,” raises the specter of denying older patients access to treatments precisely because they are old – and therefore might not live long enough to generate enough “value” from the therapy in the eyes of government bureaucrats.
The Administration’s controversial new head of Medicare, Donald Berwick, has not embraced the concerns expressed by Dr. Cosgrove and others that comparative effectiveness research will harm research in innovation. To the contrary, he has instead embraced the theories of cost-effectiveness research – to which he has devoted the bulk of his professional career – as a means for government to deny access to treatments; Dr. Berwick said last year that “The social budget is limited—we have a limited resource pool….The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open.”
As this debate moves forward, the American people should closely examine the words – and actions – of Dr. Berwick and others in the Administration, to ensure that controlling health costs, and obtaining “value,” does not come by denying vulnerable individuals needed care.