The Worst of All Possible Worlds
Cost effectiveness means asking how much you have to spend, say, to save a year of life. Without the ability to compare procedures by this measure, clinical research will provide little more than a roadmap for spending the entire GDP on health care. This is from America’s Health Insurance Plans:
Senators Max Baucus (D-MT) and Kent Conrad (D-ND) have introduced S. 1213, the “Patient-Centered Outcomes Research Act.” This bill would establish a Patient-Centered Outcomes Research Institute to generate scientific evidence on which treatments and therapies achieve the best clinical outcomes for patients. Cost effectiveness is not included.
I’ve never seen this point made before. If you just ask about effectiveness and you don’t care about costs, you will definitely end up spending a lot more on health care.
This is the other side of the coin from safety standards. Some government safety agencies use a rule of thumb: Anything below one death per million is a risk too high. The converse in health care would mean that any procedure/drug/etc. is acceptable if it saves a life in up to one-in-a-million cases. In both instances, if you ignore costs you could spend many times the GDP on largely trivial matters.
Why do people rely so much on what is said rather than what is done?
Cost effectiveness wasn’t supposed to be a part of the ALLHAT study on hypertension treatment either. Naturally it ended up playing a large part in selling the preferred results which followed the template of advanced drugs are costly and don’t do any better than cheap ones never mind the higher morbidity and mortality rates.
What makes people think that clinical effectiveness research isn’t being done now? Has medical progress depended on an Ouija board for the last 300 years?
Good point, Linda. No matter what they say, you can bet that they will be trying to limit health care for patients.