The biggest hurdle comparative effectiveness research must clear to become accepted in medicine is the idea that it will result in rationed care and kill middle-class patients.
Much of the fear is irrational, even imported.
Using science to find best practices is perfectly sound, and a refusal to engage in it drives up costs for everyone. That is the plain truth, and anyone who tries to argue you away from it does not have your interests at heart, but their own.
Trouble is, in England. which has a single-payer system, this research has resulted in something called a QALY calculation, Quality Adjusted Life Year. The government sets policies on what care it will pay for based on QALY. Procedures with a QALY of over 30,000 pounds ($48,000) are generally not covered.
Writing at the cancer journal Cure Today yesterday, UT-Southwestern professor Debu Tripathy (above) tried to offer a way out of the dilemma:
One compromise could be that a new expensive technology or drug could be conditionally approved if the sponsor agrees to conduct further studies to define subsets of patients who benefit the most–otherwise, the cost (or covered amount) would then have to fall in line with an agreed-upon cost per QALY saved.
In other words, tell us who is likely to benefit most from a therapy and we can approve it for them.
Tripathy also offers a chart at the end of his post illustrating the dilemma facing the opponents of comparative effectiveness. It measures longevity against the dollars spent on care, and shows that, at some point, spending more money to live a little longer just does not work.
Opponents of health care reform are using a rational fear of death as their chief weapon against the very calculation of cost savings. Steve Jobs got a new liver, and if you were dieing you would want one too. But a QALY of Steve Jobs is worth more to society than a QALY of you, or me.
Until we become rational, and honest about the issues, no reform is possible and the QALYs of all Americans will become fewer-and-fewer. It’s time to have a rational debate and to tell the scare-mongers they should shut up.