Blunt Tools in the Art of Healing
Years ago I heard a song by Harry Chapin:
“If a man tried to take his time on Earth,
and prove before he died what one man's life could be worth,
well I wonder what would happen to this world?”
The song is about trying to make a difference, trying to impact the world around you for good. But it raises another question – one that is increasingly relevant in the cancer community: What is the value of a human being?
Last year the FDA approved two new drugs for metastatic melanoma, both of which are demonstrated improvements over other treatments. Despite this, several other countries have decided not to make these drugs available to melanoma patients, claiming they are too expensive.
The respective agencies argue that the benefit derived from these drugs is not sufficient to warrant the expense. They reach these conclusions using complicated formulas represented by acronyms like QALY and DALY.
So the question: What is one person’s life worth? What should a person or society pay to buy six months of life? Does quality of life during that time impact the decision? Does it matter if the patient is 25 years old, or 75 years old? Should we pay $120,000 for a drug that benefits less than 20% of patients who take it? What if the number were 10%? Or 30%?
The question is complicated, and exists against a stark reality. No country has infinite resources for health care – we must spend where patients and society will get the most benefit. But when we consider the issue of cost, it’s important to look at the big picture when we compare one treatment against another. For example, one older drug for melanoma must be given in a setting similar to an ICU. One of the new drugs must be given in an infusion center. Another new one can be taken in a pill. The cost of administering these drugs varies dramatically. I spoke with one Stage IV survivor who told me the total cost of his care was over $1 million. He has been cancer free for almost ten years. Was the million dollars a good investment? It is certainly more than the cost of either of the new drugs for melanoma.
This is a debate that has no clear answers, but a few things are clear:
· We must find a way to get drugs to the market cheaper and faster. Industry must show more urgency. Academia must move more quickly, and demonstrate better decision making about what trials to conduct. Government agencies must find a way to reduce the regulatory burden on drug development.
· Yes, new drugs are often expensive, but the more patients who access it, the more we will know about it’s true cost/benefit ratio. While clinical trials are conducted with high standards and are critical for regulatory approval, the data we gather from “real world” use is invaluable. Until a drug has been tested in a broad setting no-one truly knows the full picture of the benefits of that drug.
· We must get more drugs into the clinical setting. Having multiple options for treatment puts price pressure on industry and helps lower costs. This means funding the plethora of promising research in melanoma, particularly in the area of combination trials.
I have read that insurance companies value a human life at $50,000 a year. I have seen another study that says the number should be closer to $130,000. When it is your life, or that of someone you love, a year of life is priceless.
I understand that we must cut health care costs. But flatly denying patients access to drugs that can give them additional quality life years is a blunt tool that serves the patients of today, and those of tomorrow, poorly.