As discussed earlier on this blog, the United Kingdom has an agency that does health care cost-effectiveness analysis – at a level and in a way unlike anything done by the U.S. government. That UK agency is called NICE – the National Institute for Health and Clinical Excellence. The BMJ recently published a commentary about NICE’s recommendation of the use of the new breast cancer drug Herceptin. The commentary, “How much will Herceptin really cost?”, points out some of the limited evidence of effectiveness for Herceptin. “Although the three published trials showed a statistically significant improvement in rates of recurrence, as yet, only one has shown a benefit in survival.” And the authors say the real cost of Herceptin will be borne by other patients whose treatment has to be dropped to balance the books. The authors write, “Nobody has suggested what treatments we cut in favor of Herceptin – not the media, medical advocates of the drug, the courts who upheld patient appeals, or NICE. … Political pressure, patient advocacy and media hyperbole should not determine who is treated and what they are treated with.” They predict that Herceptin may not be the last controversial case of “rationing by media.”
I marvel at the contrast between nations. In the U.S. we don't tend to have these kinds of discussions. Everything seems to get approved. Everything is advertised on TV drug ads. Politicians always wave in the direction of discussing health care reform at election time. But we never seem to have the public and social policy discussion about limited resources. Yet we have 47-million uninsured and a clearly tiered health care delivery system. Benign neglect.
Posted by schwitz at November 29, 2006 07:49 AM | TrackBack