Sunday, December 7, 2008

6 Months of life is worth SG$34,125

"Everybody should be allowed to have as much life as they can," said Joy Hardy, who has kidney cancer but the British NHS has refused to pay for the expensive drug Sutent that he needs to delay progression of the disease.

The National Institute for Health and Clinical Excellence, known as NICE, has decided that Britain, except in rare cases, can afford only £15,000, or about $22,750 (SG$34,125) to save six months of a citizen’s life.

In an NYTimes article "British Balance Gain Against the Cost of the Latest Drugs", it appears that although the British authorities are reconsidering their decision on Sutent, many other countries are looking towards NICE for suitable applications of cost effective studies as a method to control escalating costs of drugs and devices. In fact, NICE has been so successful that it is know that large pharmaceutical companies are willing to package special pricing or consider other special arrangements (eg pay only when medication is proven to work on patient) just to get NICE to nod for the UK market.

The application of cost effective studies in medicine is bound to create strong responses not only from the pharmaceutical companies but also patients who are "denied" access. Doctors who "profit" by prescribing expensive drugs will also likely raise ethical discussions as the oblique approach.

The health budget is NOT infinite in any country, to support ALL new medication and devices necessarily mean that money will dry up and proper access to care WILL eventually be denied to segments of the population. Evidence-based cost effectiveness approach looks like the way to go, unless a better method is in sight.

So, even at the political level, a price is being put on lives. At a different level, it begs the question "Whose Life is more precious?"

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