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Health Care: Cost v. Efficacy

admin November 16, 2018

An issue that is increasingly making news is money’s rightful place in health care. The swing towards assessing quality rather than treating for mere profit has not only come up in pilot programs under the Affordable Care Act–which gives incentives for quality v. quantity–but has also been debated privately among physicians everywhere. What is even more fascinating now is the sudden transparency in an apparent effort to take back a broken healthcare system.

Recently, in another attempt to choose quality health care over profit only, authors Bach, Saltz and Wittes of the renowned Memorial Sloan-Kettering Cancer Center announced in a New York Times Op-Ed that “we are not going to give a phenomenally expensive new {advance colorectal} cancer drug to our patients.” Their reason for refusal: cost. They contend that this new drug Zaltrap would run $11,063 monthly but the current drug protocol, Avastin only costs $5000 per month. They say that the current drug works. The new advanced drug is simply more expensive with no added benefits. This willingness to make public statements has also been seen among physicians who have spoken out against the latest trend of combining generic drugs to form new more expensive, single treatments.

The medical community’s embrace of open communication is striking in how suddenly it evolved. Just a few years ago, doctors were not nearly so vocal against moves made by pharmaceutical companies for what looked like profit and nothing else. It is also interesting to note that this is happening in all aspects of drug treatment, not just cancer treatment. Drug costs were a topic in a wide array of treatment discussions at last week’s Cowen Therapeutic Conference held in New York. Obesity and Diabetes drug costs were a central topic. Physicians spoke out against some of the newer weight-loss drugs, such as Qsymia, which is actually a combination of two generic drugs. The 2 generic drugs that make up Qsymia have been prescribed for years with success. What does Qsymia offer? Physician say: a higher pricetag. At the Cowen meeting, when physicians were asked whether they would prescribe the two generic drugs instead of the new costly name brand, the overwhelming consensus was “yes”.

In the Diabetes discussion, one doctor revealed that even though there was a new, soon-to-be-approved, long-acting insulin derivative, Degludec, it would not be included on his hospital’s drug protocol because its cost does not justify its value. Certainly, drug companies will undoubtedly argue greater efficacy as more and more physicians stand up against this issue.

In the rare diseases portion of the conference, an expert made a salient point. He spoke up for patients everywhere when he said that these patients have other costs in managing their disease beyond those incurred by drugs. There is a sensitivity regarding the price of these drugs for their patients. If companies want premium pricing for their drugs, they need to demonstrate premium value. However physicians do support a pricier alternative of course, if a drug is shown to help patients more than the generic option. Recently, Pfizer announced that a clinical trial comparing their lung cancer drug Xalkori against the generic standard Docetaxel and Alimta, Xaltori demonstrated superioresults. So in this case, physicians felt the pricing was justified.

One hopes that physicians will continue to speak out, putting the quality of patient care over profits (for either themselves or drug companies). This is not to suggest that physicians never cared about quality—not in the least. However this very real wave of transparency and a new meticulous attention being paid to value of care clearly shows enormous change happening. But perhaps worrisome to some is that the impetus for the focus on quality vs. cost is not entirely clear. Is it truly a trend, one likely to die out like most fads? Or is the trend likely to continue and become business as usual among members of the medical industry? Some would argue that the Affordable Care Act has encouraged physicians to speak out–would physicians feel empowered to voice their concerns under Romney’s health care plan? While the health care debate continues to evoke more questions than answers the biggest question is: is a dollars-first system of treating illness finally taking a back seat to a quality-first system of encouraging health?

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