Sun Herald

February 19, 2009

By Peter J. Pitts

 

It’s like the premise for a science fiction movie: A faceless government agency decides whether citizens live or die, based on how sick they are and how much money it will cost to keep them alive.

 

Unfortunately, such a dystopian future may not be confined to the silver screen.

 

In the just-passed economic stimulus package, $1.1 billion is earmarked toward the creation of a federal agency to conduct “comparative effectiveness research.” Such research compares newer medical treatments against older alternatives. Lawmakers promise the agency won’t be used to ration medical treatments deemed “cost-ineffective,” but elsewhere in the world, that’s exactly how such agencies are used.

 

Britain, for instance, has a government-run comparative effectiveness agency — the National Institute for Health and Clinical Excellence (NICE) — which looks at clinical trials to determine if new medical treatments are sufficiently effective to warrant coverage under the National Health Service, the country’s public insurance system.

 

Unfortunately, NICE’s cost-benefit analysis is skewed toward saving money. Many cutting-edge drugs and devices that show great promise in extending and enhancing patients’ lives are denied approval simply because the government doesn’t want to foot the bill. The result is that NHS patients have little to no access to many life-saving medical treatments.

 

A recent article in the New England Journal of Medicine reports that “NICE considers treatments cost-effective if their cost-effectiveness ratio is £20,000 ($34,000) per QALY (quality-adjusted life year).”

 

NICE has denied coverage for a kidney cancer treatment because it “only” doubles a patient’s life expectancy. Consequently, British kidney cancer patients are stuck with 20-year-old treatments.

 

NHS patients also don’t have access to many pharmaceutical drugs currently available in the U.S., including treatments for Alzheimer’s, colon cancer and rheumatoid arthritis.

Americans could lose access to these life-saving drugs too if the government establishes a comparative effectiveness agency in the States.

 

The Alliance for Better Medicine, a coalition of physicians, patient advocates, ethnic healthcare organizations and academic experts, suggests that it is difficult, if not impossible, to carry out comparative effectiveness research applicable to all patients. The ABM notes that there are “known genetic variations in response to medications based in part on race and ethnicity.” The organization cites studies showing that anti-depressants have substantially different effects on patients depending on their individual genetic makeup, metabolism, and age.

 

In other words, the American patient population is too diverse for a single government agency to be handing down rigid dictates on physician practices.

Establishing a national comparative effectiveness agency puts us on a path to a world in which cutting costs comes before saving lives. So far, that world has been the province of science fiction films. Let’s hope this new agency’s officials keep it that way.