You’ve heard the stories of how our health care system is going bankrupt and it’s because of out of control spending. Today I’ve got a story for you about a new treatment for prostate cancer that costs tens of thousands of dollars and extends life for just a few months. Medicare is going to have to decide whether or not it’s going to cover this treatment so let’s see why its job is so difficult.
A man in his early 70's finds out that he has prostate cancer and undergoes treatment. He gets some combination of chemotherapy, radiation therapy and surgery based on his specific situation. He does well for a while but after a year or so the cancer returns, spreads to other parts of his body and doesn’t respond to hormone therapy anymore. At this point there is only one medication that will prolong his life, but it will only increase it from 16 to 18 months, a total of two extra months. The kicker is that it costs about $25,000 for the drug.
Is it reasonable to pay $25,000 to extend the life of a man in his mid 70’s with metastatic cancer by two months? On the one hand, if it was you or someone you love you would probably want every day of life you could get. Given how expensive this treatment is, there’s a lot that could be done with that money that would have a much greater impact. We could pay for better diabetes care for someone in their 70’s, guarantee prenatal care for every woman or ensure that every child under 18 gets health care.
Okay, are you ready for the twist? The truth is that the medication I just described to you has been covered by Medicare for years and it’s called docetaxel. It’s the standard of care for metastatic hormone-refractory prostate cancer. In general, Medicare covers almost every drug that is approved by the FDA with little to no regard for the cost effectiveness of the medication.
The new drug I referred to earlier is sipuleucel-T (Provenge). This medication was approved by the FDA last year for metastatic hormone-refractory prostate cancer. Sipuleucel-T extends life by 4 months and costs $93,000. If we’re already paying $25,000 to extend life by two months, is it reasonable to pay an extra $68,000 for another two months?
This is a tough question and Medicare’s answer should reflect the values of our society. Cost has to play a role in determining whether a particular treatment should be covered because there’s only so much money to go around. The current answer is that if you have Medicare (or any other comprehensive insurance plan), then any effective treatment will be covered regardless of how much it costs. This only serves to drive costs up since there is no accounting for whether a treatment is cost effective and worth the extra money.
So keep your eye out for the decision today as to whether sipleucel-T will be covered by Medicare. The answer will go a long way towards telling us whether we’re ready to confront the harsh reality of the spiraling costs of our health care system or whether our heads are still in the sand.