Government-Run Healthcare: Your Life, Their Money
A brief observation from the Ghost of Healthcare Future: The United Kingdom's National Institute for Health and Clinical Excellence -- sardonically known as NICE -- has denied payment for Roche's anti-cancer drug Avastin in the treatment of advanced colorectal cancer. It's not that Avastin doesn't prolong cancer patient's lives; it does. Avastin isn't cost-effective. Says who? In the words of NICE CEO Sir Andrew Dillon, "We are disappointed not to be able to recommend bevacizumab [Avastin] as well but we have to be confident that the benefits justify the considerable cost of this drug."
In the same vein, last June NICE denied coverage of Tarceva, another breakthrough biotechnology drug from Roche for the treatment of non-small-cell lung cancer. Dillon again explains why, "These issues led the committee to conclude that, on current evidence, the cost of the drug related to the benefits it brings means that erlotinib would not be a good use of NHS money."
Point one: There's a critical difference between using your money to purchase health insurance under contract and bureaucrats deploying "NHS money" on your behalf.
Point two: Will anglophile Centers for Medicare and Medicaid Services director Donald Berwick also expect a knighthood for denying patients access to lifesaving drugs once he achieves his aim of emulating the NHS?
Point three: Explain to me once again how Sarah Palin is mentally deficient for decrying the "death panels" that couldn't possibly follow the arrival of our own version of the NHS?
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May '10
Re: Government-Run Healthcare: Your Life, Their Money
I had to learn more as I felt there had to something exculpatory. But no, further investigation proved even more outrageous:
"Cost-effectiveness is the additional cost of one year of healthy life (expressed as the cost per quality adjusted life year, or QALY, gained). The Committee considered the best available estimate for the base case ICER to be greater than £59,000 per QALY gained...
"The committee agreed that erlotinib should not be considered under criteria for evaluating life extending, end of life treatments It thought that the total population for whom erlotinib was licensed was not small enough to allow the end-of-life advice to apply.
"Smoking cigarettes, pipes, or cigars is the most common cause of lung cancer. Other risk factors include... When smoking is combined with other risk factors, the risk of developing lung cancer is increased.
This last point comes as a non-sequiter but I read it to mean that it's the patient's own fault they're sick, so we're not approving the drug. Fair read George?
Jul '10
Re: Government-Run Healthcare: Your Life, Their Money
A wee quibble: it's your life and your money, though the NICE people act as if it were theirs. What a perfectly Orwellian acronym.
Re: Government-Run Healthcare: Your Life, Their Money
Trace, that's my take as well. Instead of life-and-death decisions being made by patients, families and physicians making different choices based on individual circumstances, including financial resources, NICE gives us a quantitative, binary assessment more suited to a rocket launch than a gut-wrenching medical decision.
And Ragnarok you are absolutely right: It is your money and your life. Apologies for watering down my intended sarcasm -- I kept referring to the Ricochet code of conduct as I rewrote the headline and must have lost something.
Jul '10
Re: Government-Run Healthcare: Your Life, Their Money
What will ultimately happen is that we won't be faced with these choices very often.
These types of life-extending drugs are developed at tremendous expense for administration to a relatively small population of patients. With government making these sorts of decisions, pharmaceutical companies will no longer risk billions of R&D dollars to develop drugs that target late-stage diseases.
No one will have to make the "death panel" call about new drugs: there won't be any.
Edited on Aug 24, 2010 at 4:38pmMay '10
Re: Government-Run Healthcare: Your Life, Their Money
I'm not sure it will work that way. When drugs are moved into human trials they're not sure what they will do. These marginal result drugs will always crop up. They won't stop trying.
Re: Government-Run Healthcare: Your Life, Their Money
Um, EJ, there's nothing "marginal" about these drugs. In the world of solid tumor chemotherapy they are absolutely ground-breaking. Yes, these products are expensive and, on average, add only months to a patient's life-span. But inside that "average" are a fortunate few who do well for much longer. And, sadly, some patients don't respond at all -- like my own father during his treatment for a glioblastoma a few years back. But who gets to make the decision?
And I can tell you that we certainly will stop trying at some point. We won't want to, but when the capital dries up and the pink slip arrives it really isn't my call anymore.
May '10
Re: Government-Run Healthcare: Your Life, Their Money
George and Kenneth have hit the nail on the head. While the NHS decision in the here and now is outrageous by itself, it is the future consequences that are more outrageous. If there is no incentive for Roche to spend years and billions on developing drugs due to foreknowledge that NHS will not cover them due to their limited cost effectiveness (in NHS' eyes), then they will stop trying altogether.
And if the largest market in the world for these drugs goes the way of NHS via Obamacare, then there is really no incentive to produce these expensive life extending drugs...
May '10
Re: Government-Run Healthcare: Your Life, Their Money
Institutions like NICE are so manifestly "death panels" of a sort, that I wonder where we'd be if the Krauthammer's of the world had used their immense talents to defend and bolster Palin's point rather than dismiss and even mock it. They foolishly allowed their disdain for the messenger to undermine what should have been the essential conservative message of this whole debate.
Palin is at times cringe-inducing, yes, but on this point she clearly was more clear-thinking than the usually brilliant Dr. Krauthammer. I wonder if, now, looking back, he'd concede that he was in error, because it surely was an opportunity missed, and it's very tough to win back that ground.
May '10
Re: Government-Run Healthcare: Your Life, Their Money
I am involved with a local foundation that promotes lung cancer research and education, and am in regular contact with many people who receive these therapies, particularly Tarceva. The results for many of them are nothing short of miraculous. In some cases they have seen their tumors shrink and cease any measurable biological activity; in some they achieve full remission; and in others their disease is controlled for many years, a chronic, survivable condition like AIDS has become.
Obama loves medical sob stories, so here is one for him: A mother of two small girls aged 2 and 4, a non-smoker, is diagnosed at the age of 33. The tumor has infiltrated her pericardium, and surgery is risky and will leave her heart compromised. Her oncologist prescribes Tarceva, and it stops the disease cold, shrinking her tumor and rendering it PET-negative. In time she may need a different treatment, but meanwhile she gains years with her husband and children that would otherwise be lost to them, and she may even be able to return to her thriving dental practice.
So what do you call a government panel that would deny this young woman that lifesaving treatment?
May '10
Re: Government-Run Healthcare: Your Life, Their Money
The issue is not development of drugs, it is testing and approval of them. Whenever I hear conservatives claiming that R&D will go away, I want to scream. The world is full of gung-ho scientists staying awake all night chasing therapeutic interventions because of a desire to get glory and achieve goals, not rich.
The problem is that the FDA regulatory processes, as well as the chilly damp blanket tossed over the system by ambulance chasers, drive up the cost of clinical trials to the extent that it is hard to get approval to use.
The pharma business models are going to change- drastically- more for scientific and pipeline reasons than because of ObamaCare (that is, admittedly, bad enough by itself). Why? Because the low-hanging fruit of single intervention compounds is about gone.
The new drugs George describes are biologics- multiple action compounds that operate the way our physiology operates, e.g., stimulating the immune system (e.g., every drug name that ends with "mab" is a monoclonal antibody, not some chemical molecule).
I wish that the anti-glio vaccines that are saving rats right now had been around when George's dad fell ill.