Tuesday, June 30, 2009

Cost Effectiveness Research

According to an Institute of Medicine press release,

A new report from the Institute of Medicine recommends 100 health topics that should get priority attention and funding from a new national research effort to identify which health care services work best. It also spells out actions and resources needed to ensure that this comparative effectiveness research
initiative will be a sustained effort with a continuous process for updating
priorities as needed and that the results are put into clinical practice.

This report was required by the Recovery Act, which set aside $1.1 billion for government studies of health care cost effectiveness. Here are a few examples of the recommended health topics:

Compare the effectiveness of treatment strategies for atrial fibrillation
including surgery, catheter ablation, and pharmacologic treatment.

Compare the effectiveness of the different treatments (e.g., assistive listening
devices, cochlear implants,electric-acoustic devices, habilitation and
rehabilitation methods [auditory/oral, sign language, and total communication]) for hearing loss in children and adults, especially individuals with diverse cultural, language, medical, and developmental backgrounds.

Compare the effectiveness of primary prevention methods, such as exercise and balance training, versusclinical treatments in preventing falls
in older adults at varying degrees of risk.

Compare the effectiveness of upper endoscopy utilization and frequency for patients with gastroesophageal reflux disease on morbidity, quality of life, and diagnosis of esophageal adenocarcinoma

Rather arcane. A more direct point was made in a commentary of the Journal of the National Cancer Institute. AFP reports that

According to study authors Tito Fojo, an oncologist at the National Cancer Institute, and Christine Grady, an NIH bioethicist, an 18-week course of cetuximab [manufactured by Merck under the Erbitux trade name] for a lung cancer patient would cost about 80,000 dollars and extend the patient's life by an average of 1.2 months.

Using the drug to extend a patient's life by a year could cost 800,000 dollars, the authors wrote.

It would cost 440 billion dollars annually, a figure 100 times more than the National Cancer Institute's budget, to extend by one year the lives of the 550,000 Americans who die of cancer each year.

The authors recommend that studies geared towards treatments that will extend patients' lives by two months or less only consider interventions that will cost 20,000 dollars or less.

That's a hard decision.

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