Friday, November 12, 2010

Friday Quiz: Rationing in the UK and the US

From Britain yesterday came word that the National Institute for Health and Clinical Excellence (NICE) refused National Health Service (NHS) funding for the life-extending drug Avastin, due largely to its expense.  (Also of note: The FDA is still considering its own separate review of Avastin for treating breast cancer; a previous Washington Post article noted that the review should not consider cost issues – but if the FDA revokes its approval, Medicare will stop paying for the drug.)  This story seemed eerily similar to reports in the Washington Post on Monday that Medicare may refuse to pay for the prostate cancer drug Provenge due to its cost.

Which brings us to this morning’s quiz.  I’ve attached below a series of quotes from the BBC article on NHS rationing and the Post piece on Medicare’s cost-effectiveness review.  Can you tell which series of quotes refer to Medicare’s decision-making, and which relate to the NICE-imposed system of cost-based rationing…?  (Answer is below.)

This development comes a few days before Dr. Donald Berwick is scheduled to testify before the Senate Finance Committee in his first appearance before Congress since his controversial recess appointment.  Dr. Berwick has previously stated that “we could learn from and adapt” the British model of cost-based rationing – and given the series of quotes below, some may wonder whether that process has already begun.

Country A Country B
“The treatment costs $93,000 a patient and has been shown to extend patients’ lives by about four months.” “Research shows the drug can give an extra six weeks of life.”
“To charge $90,000 for four months, which comes out to $270,000 for a year of life, I think that’s too expensive.” “At a cost of nearly $21,000 per patient, the drug is just too expensive.”
“I’d like to think cost doesn’t need to come up when it’s a slam dunk….But when it’s a close call like this, it certainly has to be a factor.  That’s $100,000 [we] can’t spend elsewhere.” “The independent committee that makes the final decision needs to be certain that the benefits offered justify the cost.”
Oncologists’ reaction: “Firing a shot across the bow like this is not the way to have an intelligent and meaningful discussion about how we start to address the complex issue of drug costs.” Cancer group’s reaction: “We believe that all treatment options should be ruled in, regardless of cost, giving doctors and their patients the freedom to choose the treatments that are right for them.”



Answer to the quiz:  Country A is the United States, based on Monday’s Washington Post story about Medicare’s cost-based review of Provenge; Country B is Great Britain, based on yesterday’s BBC story about NHS coverage of Avastin.  Quotes have been edited lightly above to disguise the country being discussed.