Thursday, January 22, 2009

Proposal to spend 1.1 billion to save money and lives

There is a bill before the House of Representatives that would fund a project to study comparative effectiveness of new medications and medical devices. I believe this is House Bill S-3408 offered in 2008.

Advocates claim not only would money be saved but so would lives. Interestingly, the governmental Congressional Budget Office has apparently said that this type plan will not really save much ( see here for a 2007 GBO report on the issue of costs and benefits from a comparative effective research center) and I wonder how would such a program save lives.

The British agency ( called NICE) that is in charge of approving or limiting certain treatments for certain conditions in Great Britain arguably has cost lives by disallowing certain treatments. See here for a 2008 NEJM article touching on some of the pros and cons of this British agency including certain of the denials of care that attracted more than a little press coverage.

I believe the argument for its life-saving function might run like this: By limiting certain treatments that are not cost effective we can shift the money to other treatments which will save more lives, i.e. more lives saved for the buck., a utilitarian claim of the greatest good for the greatest number. In the NEJM article we find this quote from the chair of NICE which captures that line of thinking fairly well: If we spend a lot of money on a few patients, we have less money to spend on everyone else. We are not trying to be unkind or cruel. We are trying to look after everybody."

Looking out for everybody is a tough job but cost effectiveness analysts claim they are up to the task as apparently did Dr. David Eddy in a series of articles in JAMA over ten years ago that proposed that type of planning and control within the context of health care entities such as HMOs, a topic I wrote about here expressing my opposition to Eddy's philosophy.

See here for a op-ed expressing concern about the current House bill by Dr. Scott Gottlieb.

The NEJM author summed it up this way " .. such an institute could help to improve quality and slow escalating costs only if it were able to make tough calls and remain independent of political and financial interests."

When big bucks are involved remaining independent seems very unlikely.

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