Monday, March 10, 2008

Learn to Play God--Be a Bureaucrat

In this NYT editorial that questions the FDA's approval of Avastin for breast cancer, we see almost everything that's wrong with single-payer health care:
The key study showed that when used with another drug, Avastin almost doubled the time cancers were held in check before starting to worsen. It also doubled the number of women whose tumors shrank significantly.

It did not extend overall survival rates and caused more serious side effects, including perhaps half a dozen deaths. That seems like a modest basis for approval pending completion of additional clinical trials. The quandary is whether an extra 5 1/2 months of holding tumor progression at bay is worth toxic side effects.

The drug is already prescribed “off label” for some 11,000 American women with advanced breast cancer, but the latest approval is expected to increase its use among some 43,000 women deemed suitable candidates for treatment. The cost could be enormous. Genentech charges about $92,000 a year for breast cancer patients. For women with annual family incomes below about $100,000, it caps the charges at $55,000 a year.

The company argues that Avastin emerged from many years of costly research. It does not claim that the drug is cost-effective for advanced breast cancer but believes it will clearly be worth the cost if shown effective in earlier stages of breast cancer.

Britain’s National Health Service has balked at paying for Avastin for breast cancer patients. If this country hopes to get escalating health care costs under control, it will need a way to determine which treatments are worth paying for, and which are not. The case of Avastin is a reminder of just how difficult that can be.
No, it's not difficult at all, as long as it's being paid for privately. It's not the FDA's job to determine cost-effectiveness, which the FDA knows but apparently the New York Times finds objectionable. It's fine to note that Avastin is hideously expensive and may ultimately not be worth it. It may even be a legitimate function of government to publish cost-effectiveness data.

But wouldn't it be, oh, kinda nice if a woman with breast cancer had the ability to decide on her own whether she'd like go to the expense of using the drug?

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