NICE Isn’t Very Nice
One of the more radical proposals of Tom Daschle, incoming head of the Health and Human Services, is a governmental organization to evaluate the cost-effectiveness of medical treatments. In Britain, a similar organization, the National Institute for Health and Clinical Excellence (NICE), is charged with deciding which treatments the British National Health Service will pay for and which it will not. NICE considers a treatment cost-effective only if the cost per quality adjusted life year (QALY) is £20,000 or less (about $35,000). The result is that many advanced cancer treatments (and other therapies) available in the United States and on the European continent are judged too costly and not available to patients in Britain.
Study here [gated, but with abstract].
Irony of ironies. Suppose you place a value on a year of your life of more than $35,000. Then in Britain you are free to buy the care the government denies you in the private marketplace.
However, that means that lifesaving care is dependent on ability to pay.
Yet the primary reason why the British established the NHS is so that care would not be based on ability to pay.
The scary thing is that Daschle wants to do this in the United States.
New York Times 12-17-2008 about Medicare coverage of prostate cancer link follows: http://www.nytimes.com/2008/12/17/health/policy/17knife.html?pagewanted=1&_r=1&em
I gave testimony at the following meeting regarding Medicare coverage of prostate cancer.
“Official Testimony of
Fred >>>>>, Patient
On
SBRT Treatment of Cancer of the Prostate
Palmetto GBA/Medicare Open Draft LCD meeting
November 18, 2008
Good morning Palmetto GBA administrators, doctors and other interested parties. Thank you for allowing me to discuss Medicare coverage of SBRT/CyberKnife for treating prostate cancer.
My name is Fred >>>>>> and I am a small business owner. I am testifying on behalf of myself as an interested party, a prostate cancer patient treated with the CyberKnife and a prostate cancer advocate. I am also a founder of ZERO the Project to End Prostate Cancer.
I was diagnosed with prostate cancer (PCa) in Aug. of 2007. My PSA was 4.0 ng/ml, a transrectal ultrasound-guided biopsy revealed a stage T1c adenocarcinoma involving the right mid to right apex with a Gleason score of 3+3; in 3 of 12 cores.
I discussed all treatment options with my family doctor, doctors at Stanford, Surgeons and Radiation Oncologists. I reviewed all options with my wife. As a father of a nine year old son, Business owner, treatment recovery time was an important consideration. I have a clogged artery which made the risk of surgery higher than I was willing to consider.
I selected SBRT/CyberKnife treatment option for prostate cancer at Stanford. Their clinical trial data, started Dec. 2003, was very encouraging with ZERO biological failures and minimal side effects (my research suggested the CyberKnife is at least as effective as IMRT). My CyberKnife treatment was five days of one hour sessions with no recovery time (IMRT is five days per week for eight weeks). I was advised of and understand the long term risk of radiation side effects and felt the advantages of SBRT/CyberKnife treatment far out weighted the long term risk.
I completed CyberKnife treatment (May 7, 2008) by Dr. Christopher King. Fourteen days post CK treatment there were minimal side effects. I continued to work every day during and after treatment.
It is now over six months post CyberKnife treatment. I am 110% of pretreatment base line for all related functions. The plus 10% is from improved urinations. Before treatment I would get up 3-4 times a night now I typically get up once. My PSA at the six month follow up was 1.09 ng/ml. SBRT/CyberKnife has treated my prostate cancer and has improved my quality of life.
The key messages I hope to impart to you today are:
1. The previous Medicare contractor in California, NHIC, provided coverage for SBRT/CyberKnife treatment for prostate cancer.
2. SBRT/CyberKnife treatment for prostate cancer is consistent with the Presidents statement from his press conference announcing the MMA of 2003. With this law, we’re giving older Americans better choices and more control over their health care, so they can receive the modern medical care they deserve.
3. SBRT/CyberKnife treatment for prostate cancer is consistent with Mark B. McClellan, M.D. PhD Administrator. “Our nation has made a promise, a solemn promise to America’s seniors. We have pledged to help our citizens find affordable medical care in the later years of life.”
4. As outlined in the CMS Statement of Work for the Palmetto Medicare Jurisdiction (J1), and on Palmettos Website: The MAC shall select the least restrictive Local Coverage Determination (LCD) from the existing LCDs on a single topic when consolidating LCDs. CMS has identified that there may be instances where the decision to implement “no policy” would meet the definition of the “least restrictive LCD”.
5. There are no prostate cancer treatment options without serious risk of permanent side effects and biological failure.
6. The patient in consultation with his doctor(s) must decide what treatments are appropriate for their unique circumstance.
a. Some patients live in rural areas with limited or no local treatment centers.
b. Some patients have medical conditions that make surgery a high risk.
c. Some patients have limited mobility making treatment very difficult.
d. Some patients continue to work full time and this trend is increasing. Making treatment recovery and time away from work an important factor.
e. Some patients have limited financial resources that limit treatment options due to cost of travel, food and lodging.
7. The majority of Medicare Contractors include SBRT/CyberKnife treatment for prostate cancer.
8. Blue Shield of California the largest insurer in the state, in July of 2008, added SBRT/CyberKnife to their policy for treatment of prostate cancer.
All of the above support Medicare coverage of SBRT/CyberKnife treatment for cancer of the prostate.
Please consider the fundamental right of patients to make treatment decisions for themselves in consultation with their doctors and families, and for the patients well being and overall quality of life.
I have no financial interest in Accuray Inc., Stanford University Medical Center or any other medical provider.
Thank you for this opportunity to appear before you today.”
Viperfred: interesting connection. We covered the CyberKnife story at this site here: http://www.john-goodman-blog.com/medicare-equal/
It appears that Medicare contractors are already making Daschle’s NICE decisions for him. Yet no one can seem to explain why or how the decisions are being made.
Whether it’s a CyberKnife or a cancer drug, there will always be pressure to save money by denying patients care.
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[…] be modeled on the British National Institute for Clinical Effectiveness (NICE). But, as explained here, Nice is not very nice. It is the basis for rationing health care in […]
Interesting Blog there pal.