Thursday, 29 November 2007

Who lives, who dies?

This morning I heard a story on the Today programme about health economics. A radiotherapist was saying that for the money spent treating 500 women with Herceptin he could treat 3000 women with radiotherapy.

The discussion was sparked by The Investigation – a programme to be broadcast this evening. It will ask why cancer survival rates are the worst in Western Europe, despite “huge government expenditure”. (Don’t worry if you can’t catch it this evening – it’s available as a podcast and through listen again.)

The problem is that no pit of money is bottomless. Yesterday’s Today programme had a discussion on the need to increase spending on defence. John Humphries asked where the money was to come from – which other budget would they slash to pay for it – education, health or transport? The interviewee tried to avoid the question, saying that the amounts were only small. Presumably they are, but if it’s your school that has to close, or your village bypass that doesn’t get built, then it really doesn’t help to say that it’s only a small amount of money.

BBC news says that Herceptin costs £200,000 per patient. In the bigger scheme of things, that’s nothing. You couldn’t buy a house with that, a city banker would be insulted to have it as his annual bonus, but to the woman who receives successful treatment it’s worth every penny. On the other hand that was £200,000 that could have bought different treatment for different people – perhaps more people. It's £200,000 that can only be spent once and represents people who missed out because of that.

One of the speakers in today’s discussion reminded us that every patient is a mother, sister or daughter and on that level it is impossible to make choices. This is reflected in the titles of books on the subject – Who Should We Treat?, Hard Choices in Health Care.

Here some other starting points for thinking about healthcare rationing or spending priorities.

A 2005 BMJ editorial looks at “A middle way for rationing healthcare resources”

The Office of Health Economics has an online resource on health economics.

The think tank Civitas asks “Why Ration Healthcare?”

Herceptin has caused controversy before and the BBC has a collection of pages looking at value for money from drugs, drug rationing and “patient power” where an articulate patient with the money to bring in lawyers and the foresight to involve the media overturns a local decision to get funding for a drug…which may or may not then save their life.

(c) creative commons - image 1, image 2, image 3

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