How Do You Put a Price on a Few Months?

“All patients want to be the tail end of the survival curve.”
-Dr. Schrag

Quoted in: 'Costly Cancer Drug Offers Hope, but Also a Dilemma' - NYTimes

Prolonging life is one of those tricky medical issues that makes The Happy Hospitalist drool and twitch, especially for those at the latter end of their lifespans with a bleak clinical picture.

But what about the case of Avastin, an expensive cancer drug that may extend life by 4 months or so, for the bargain basement price of almost $50,000?

How would you respond if your doc told you a cure wasn't clinically possible, and your only recourse was to "manage your cancer?"

I doubt many of us could predict what we'd do in that scenario. The decision is as individual as your genotype, so I can only speak from a personal perspective.

My first impulse would be to extend life a few months to tie up loose ends - and finally get to the top of the Eiffel tower (2 attempts - 2 strikeouts), even if it meant eating the cost of Avastin somehow.

If you're uninsured/underinsured, to 'afford' spending that much to prolong your life for 16 weeks, you'd have to be making more than $150k a year, and that's JUST to cover the cost of the drug.

This figure doesn't include "legacy costs" (a polite term for describing a terrible series of arrangements) like establishing a will, setting aside money for burial/cremation and funeral services, or paying for any of the rest of care that might be incurred in the end-months, including chemo which often accompanies Avastin use, radiation, hospice, home health, etc).

However, Genentech, maker of Avastin, places the cost for the insured around an average of 129 bucks a month.

So wait. If I'm insured, with terminal cancer, and want an extra 16 weeks to play with, I'd need to make, oh, $516 to cover the cost of my pharmaceutical preservative?

And if I'm uninsured, the price of my ticket to ride the Avastin river of life for 4 months equals the average annual salary of a US school teacher?

Who decides if the cost of the drugs are worth it? The patient? The physician? The person at Genentech's PAP (pharmaceutical assistance program) who reviews my application for reduced/free drugs?

For the first time the disparities of concierge care and covered vs. not covered really hits home.

I don't know how I've missed it. In talking about patient access, I usually blog in 'participatory,' action/interaction based terms, not 'commercial' transaction based terms. And despite how often I harp about healthcare being a business, I somehow avoided thinking deeply about 'misaligned' incentives for patients.

In certain scenarios, those covered by health insurance in the US can actually. afford. to. live. longer.

Money can't buy you love, but in some cases it can buy life.

Food for thought: Read this NYTimes article.

How do you put a price on a few months?

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