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What is a Year Worth

Posted 5/6/2016

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  When one peels away all the details and figures and pontificating and hysteria around health care costs, the central question seems to be this: What is an additional year (or week or month) of life worth?

  Of course there is no single answer, and there is no real analogy elsewhere in life. The closest I can come is thinking about court judgments re payments to families after accidental or murderous deaths. I think there are actually tables to help calculate those numbers, and the figures are related to age and occupation and anticipating earnings (now lost) of the victim. What is clearly different is that, in considering medical treatments and health care costs, the victim/patient is alive and part of the conversation. More than part of the conversation, the patient is the key player and out to have the trump vote.

  Writing that last sentence fills me with anxious uncertainty because, although it sounds good, I don't think it is always true. What if the patient is very compromised, physically and psychologically, and there is clearly no hope of improvement, but s/he is not able to make a thoughtful decision about the next super expensive treatment? Her family and caregivers may believe that she would never choose to bankrupt her survivors, but what if that is what she is saying in these final days?

  This is more conversation than is possible here, but it is one that we as individuals and families need to be having--and surely one that our society needs to encourage and support.

  From Susan Gubar in the New York Times comes this excellent essay

Pricing a Year of Life
By SUSAN GUBAR

A radio producer investigating cancer costs once asked me, “What is another year of your life worth?” During my flummoxed silence, she informed me that experts mention the figure $50,000. Can patients like me — older people with recurrent disease — estimate the expense of a future year of cancer treatment to decide whether it’s worth it?

I began to understand the origin of the number when my nephew sent me an article in The New England Journal of Medicine, “Updating Cost Effectiveness.” Its authors explain: “For more than two decades, the ratio of $50,000 per quality-adjusted life-year (QALY) gained by using a given health care intervention has played an important if enigmatic role in health policy circles as a benchmark for the value of care.”

Used by economists, the QALY calculates quality and quantity of life to judge the monetary worth of medical inventions. Since my cancer was diagnosed in 2008, I have wondered how to make this reckoning within our for-profit health system. So with misgivings I set aside the plight of the uninsured and began considering not generic measurements of cost-effectiveness but how much I — as an insured patient — had paid for one year of cancer treatment.

Read more: http://well.blogs.nytimes.com/2016/05/05/pricing-a-year-of-life/?_r=0

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