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What We're Talking About When We Talk About Value

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NPR's All Things Considered host Audie Cornish interviewed a prominent cancer doctor Monday about his public criticism of the high cost of cancer drugs....

NPR's All Things Considered host Audie Cornish interviewed a prominent cancer doctor Monday about his public criticism of the high cost of cancer drugs.

Cornish starts by asking Dr. Leonard Saltz, chief of Gastrointestinal Oncology at Memorial Sloan Kettering Cancer Center, to talk about how the high prices of cancer drugs don't seem to be related to their value. Saltz answers that a lot of the drugs being talked about at the annual meeting of the American Society of Clinical Oncology, where he spoke out about those high prices, do show a lot of benefits for patients,

"...but when I broke down what it would cost to treat an average-sized American with those drugs for a year, it would've been $300,000 per patient per year. And when we talk about value, we have to talk about the benefit as well as what it costs." [emphasis mine]

The conversation turned to pharmaceutical company profits and to reactions to Saltz's speech at the conference. But it seems there wasn't time to delve into what exactly we mean when we talk about value in health care. Perhaps I can help re-frame the issue as one of cost effectiveness.

This is something I reported on when investigating the high cost of hepatitis C medications ("The Uncomfortable Math of Hep C Treatment") - some of which can cost $90,000 or more for a course.  I've been thinking quite a bit about what I learned from health care economists and doctors about figuring out the cost effectiveness of these treatments. But it's even more interesting when it comes to cancer drugs. Some of the new hepatitis C medications have high cure rates - so you're paying for a cure, not a treatment. There's no cure for cancer, so the cost of those drugs might be borne for years, to keep a patient alive or slow the cancer's progress.

Let's say you have a particular kind of cancer. There's a drug available that might extend your life by three months. It might have some serious side effects. It costs $100,000, of which you might have to pay a hefty portion, depending on your insurance, plus it's a big cost for the health care system. In other words, the drug might allow you to live long enough to see your grandchild graduate, but that might come at a cost to your quality of life (not to mention your bank account). Is it worth taking the drug?

Patients and doctors get to answer that question for themselves. But you get the flavor of the messy choices we're dealing with: the greater good, the quality versus the quantity of life. The value of some of these drugs is certainly clear sometimes - lengthening life, for example. But as the oncologist Leonard Saltz says, when you talk about value, you have to consider the costs. Sometimes those costs are personal, like bankruptcy or debilitating side effects. Sometimes they're less tangible but just as real: higher health care costs.

In the United States, these decisions are personal. But in other regions, like the United Kingdom, the health care system determines what it will pay for, in part, based on cost effectiveness, prioritizing the most cost effective treatments given limited funds. We may have more choice in the U.S., but as many have pointed out, so much choice may not be fiscally sustainable.

What We're Talking About When We Talk About Value
What We're Talking About When We Talk About Value