What would you pay to live 4 months longer? (1 Viewer)

[DrStrange]

I have seen a number of commercials for a new drug - Opdivo - that adds four months to the life expectancy of the typical end stage cancer patient with a narrow number of cancers. (from six months to ten months.) This struck me as an off thing to advertise on 'main stream" TV, so I got curious and did some digging.

Basic data (best I could figure doing a quick study):
* The drug has been tested for some lung and skin cancers but is in the process of testing for a far wider range of cancers.
* The median patient saw life expectancy rise from six months to ten months. No idea about quality of life.
* The daily cost of treatment is ~$1,000 per day or $300,000 over the ten month lifespan of the patient
* A more expensive course of treatment is being tested, costing ~$3,000 per day and maybe adding another month or two to life expectancy. This treatment will cost a bit more than a million dollars per person.
* Depending on how these expansive tests works out, the company will eventually sell $100,000,000,000 to $300,000,000,000 (100 to 300 billion dollars) worth of drugs per year to US cancer patients if everyone who could benefit from the drug gets it at full price.
* For perspective - The 2015 discretionary military spending cap is $521 billion.
* Total prescription drug spending in the USA in 2014 was $374 billion.
* 2014 spending on food stamps was $74 billion.

So now I know why the drug company is advertising - this could be the most "valuable" drug ever invented. Of course the tricky part is getting someone to pay for it. The easy answer is let the tax payers pay for it through Medicare/Medicaid. I can't see how that could possibly be fiscally sustainable but knowing how motivated / desperate the dying can be maybe it will prove hard to say no.

I am mindful that the free market price for a patented life saving drug is everything you own and everything you can borrow (and for sure everything the insurance company / taxpayer will pay.) But I am not so sure the free market solution is best in this case. Keep in mind this isn't curing anything and is not extending the productive life of the typical patient, it is taking an end stage cancer victim and stretching out the final months of their life.

Maybe we let people die a few months faster if they don't have a million bucks? That would seem to be a departure in practice.
Maybe we have the government step in and greatly reduce the price? Though I can't see how that is legal.
Maybe we raise taxes and/or borrow the money to pay the asking price? And then we go broke even faster.

Let's be clear. In 2015 the costs for Opdivo are going to be relatedly modest. But in short order these types of costs are going to be crushing and force us to make hard choices. For me, the easy answer is "let the patient die unless they have personal wealth to afford a million dollar drug". But the optics of a pleading grandmother and her family begging for help are going to be tough.

DrStrange

PS and in case the economics of this aren't clear - if we make insurance companies / medicare / Medicaid pay for this treatment then the cost of insurance is going to rise significantly. Insurance just spreads the risk, in the end we collectively pay the total costs.

 

[slisk250]

I would never pay much for a drug like this. I presume the quality of life isn't any better and I think I'd be a complete schmuck for spending the cash that would otherwise keep my healthy kids and wife alive.

The other economic points raised are interesting but unless the total cost of treatment was fixed (regardless of how long you lived) - I wouldn't do it for more than $5K out the door.

 

[tommythecat]

This is something that is based 100% on emotions. You are paying for an extra 4 months of dying, because lets face it, you aren't really "living" as a cancer patient that close to death. For me, the most I would pay is $0. If it was four months of healthy life and I had a credit card with no limit, then we can talk.

 

[jbutler]

I would only echo slisk and tommy above. Bring on the death panels imo.

 

[Mental Nomad]

1. Quality of life really, really, really matters. Sometimes the quality of life is far better without any treatment, whatsoever.
2. This makes me think of Glorious Sunset. http://freakonomics.com/2015/08/27/...ious-sunset-a-new-freakonomics-radio-episode/

Worth a listen, but to summarize:

If you had a terminal condition, and the insurance company were prepared to pay $200,000 to treat you as you die... but they offered to give you $100,000 cash if you agree to skip treatment altogether... would you take it?

You could kick things off your bucket list, or leave something for the kids... or skip the $100,000, and get all the treatments to extend your life.

 

[Ronoh]

Obvious answer is obvious, I'd cross the border into Canada and get a years supply for twenty bucks.

 

[tommythecat]

1. Quality of life really, really, really matters. Sometimes the quality of life is far better without any treatment, whatsoever.
2. This makes me think of Glorious Sunset. http://freakonomics.com/2015/08/27/...ious-sunset-a-new-freakonomics-radio-episode/

Worth a listen, but to summarize:

If you had a terminal condition, and the insurance company were prepared to pay $200,000 to treat you as you die... but they offered to give you $100,000 cash if you agree to skip treatment altogether... would you take it?

You could kick things off your bucket list, or leave something for the kids... or skip the $100,000, and get all the treatments to extend your life.

You would think insurance companies would get behind an idea like this. I would take the money 100% of the time and I imagine most people would.

Being able to leave your family a nice chunk of change after you go probably does a lot for the person dying wrt stress and acceptance of fate. It would also save untold millions in wasteful health care spending.

I say this as someone who watched my grandmother go from full of life to dead in the span of a couple months due to cancer. If you had asked me then I would have the exact same opinion.

 

[Mr Tree]

You would think insurance companies would get behind an idea like this. I would take the money 100% of the time and I imagine most people would.

Being able to leave your family a nice chunk of change after you go probably does a lot for the person dying wrt stress and acceptance of fate. It would also save untold millions in wasteful health care spending.

I say this as someone who watched my grandmother go from full of life to dead in the span of a couple months due to cancer. If you had asked me then I would have the exact same opinion.

I hope you realize it would be illegal for an insurance company to make an offer like this.

 

[tommythecat]

I hope you realize it would be illegal for an insurance company to make an offer like this.

Yes I do realize that, though it wasn't very clear in my post.

 

[Tommy]

+1 Save it for the family.

 

[NiceShot]

Say goodbye to the family and let them make use of the 300k rather than put them into debt. When it's time, it's time.

 

[DrStrange]

There is a solid body of research about how people's thinking changes when actually facing death rather than hypothetically facing death. And the same likely is true for the family. There are longitudinal studies where a fiscally responsible philosophy in a healthy elderly person becomes "damn the costs" when actually deciding how to face a life ending illness.

Offer someone a faint hope and in many cases the cost (most of which is paid for through insurance or government assistance) pales in consideration of death. (and we poker players should understand this thinking well - we see it in the villains game and sometimes our own game. Just a slim draw is often good enough to justify a call.) I expect the best case result of this medication is a long remission. Maybe only 1% or 2%, but a thin chance is better than none if one is spending someone else's million bucks.

Though I intentionally worded the question about how you look at this for yourself, the actual question in the real world is what do we think should be paid for a stranger's treatment. That is going to be the policy question up for grabs. How do we justify the government making a decision based on cost vs the "best interests" of the patient? And if we do, then the story about death panels becomes a lot more real. The problem isn't going to slam into society at full speed, its going to be a slow boil. We already see the leading edge of this with medication costs driving health care inflation but it is going to get a lot worse. You don't have to imagine hard to see how the opposition "news" station is going to make heart rending stories about the wicked plans to kill grandma just to save a buck.

And let's note for those of us with copays - the insurance deal is reality. Turn down the million dollar drug and they will give you $200,000 in the form of a co pay you didn't have to make.

DrStrange

 

[slisk250]

1. Quality of life really, really, really matters. Sometimes the quality of life is far better without any treatment, whatsoever.
2. This makes me think of Glorious Sunset. http://freakonomics.com/2015/08/27/...ious-sunset-a-new-freakonomics-radio-episode/

Worth a listen, but to summarize:

If you had a terminal condition, and the insurance company were prepared to pay $200,000 to treat you as you die... but they offered to give you $100,000 cash if you agree to skip treatment altogether... would you take it?

You could kick things off your bucket list, or leave something for the kids... or skip the $100,000, and get all the treatments to extend your life.

If I were offered that money today after learning in the morning that I was terminal, maybe would live a year, and there were no options except the drug or the money, I'd take the 100 large and give it to both my sons for college. Haven't filled that bucket yet and I wouldn't be thinking too much about bucket lists. I'd be spending that time with a few close friends and my immediate family. Probably play a few big poker games too.

 

[Mental Nomad]

I hope you realize it would be illegal for an insurance company to make an offer like this.

That's a debatable point, depending on the circumstances. Individuals have the right to refuse particular treatments. There is often a choice of multiple treatments for a given condition... and we're talking not about something where there's a chance of a cure, but rather, something that's terminal... and we're choosing between, say, six months of relatively pain-free life (given palliative care in the form of inexpensive, habit-forming painkillers - and the addiction to painkillers is solved promptly at six months), versus 12 or even 18 months of treatments likely involving a lot of unpleasant side effects, such as nausea, weakness, inability to participate fully in life...

Much depends on what you expect to happen in the next 12 months, but it's not such a stretch to think you might enjoy a pain-free six months with $100,000 extra cash in your pocket over twelve months of inability to participate in life, without a dime to show for it.

The episode I linked is well-presented, and well worth a listen.

 

[Mr Tree]

That's a debatable point, depending on the circumstances. Individuals have the right to refuse particular treatments. There is often a choice of multiple treatments for a given condition... and we're talking not about something where there's a chance of a cure, but rather, something that's terminal... and we're choosing between, say, six months of relatively pain-free life (given palliative care in the form of inexpensive, habit-forming painkillers - and the addiction to painkillers is solved promptly at six months), versus 12 or even 18 months of treatments likely involving a lot of unpleasant side effects, such as nausea, weakness, inability to participate fully in life...

Much depends on what you expect to happen in the next 12 months, but it's not such a stretch to think you might enjoy a pain-free six months with $100,000 extra cash in your pocket over twelve months of inability to participate in life, without a dime to show for it.

The episode I linked is well-presented, and well worth a listen.

I don't think it is very debatable at all. Insurance companies aren't in a position to make that kind of call. If they started making monetary offers to insureds to reject life saving/prolonging treatments they would be skewered in both the media and by our national legislature. My area of expertise is not health insurance but I am an insurance professional.

 

[links_slayer]

I work for a drug development contract lab. I'm also a cancer survivor. I'm not sure my thoughts are unbiased on several issues identified in the OP so I'll just sit idly and enjoy some popcorn.

 

[Poker Zombie]

If the drug is available, it should be made available to everyone. If this requires govt intervention, then fine - life liberty and pursuit of happiness.

But if the drug is only available to the very rich, this is just wrong. $$$ should not be the basis of life in America.

 

[Mr Tree]

If the drug is available, it should be made available to everyone. If this requires govt intervention, then fine - life liberty and pursuit of happiness.

But if the drug is only available to the very rich, this is just wrong. $$$ should not be the basis of life in America.

Philosophically I agree. Unfortunately it doesn't always seem to play out that way. I think the real question is is the cost of treatment justified?

 

[BiGGyT]

I think if it were 6 months of pain and agony, I would opt for camping in Alaska without a sleeping bag, tent, fire, etc. wearing a salmon coat and covered in honey.

 

[Puggy]

Would like to get to see, what's on teh other side and save the money for those who could really need it. No kids, so maybe to the next Ms. Puggy

 

[dennis63]

One of my closest friends spent many years as a high-ranking researcher for a large pharmaceutical firm. He sought new ways to fight cancer. What I learned from him was shocking.

The idea of a "free market" is great. In the world of medicines, though, there really isn't one.

Outside of the United States, most countries regulate the price of prescription drugs. They say to GSK (or whoever), "If you want to sell baby shampoo and aspirin and soap and suntan lotion in our country, we will pay $X per dose for your new heart medication, but no more."

The drug companies, anxious to make a profit on the OTC stuff, usually agree to this, and charge Americans a bit more for the drug, since, hey, we're a "free market."

So, at least according to someone who knows, it's not, "Americans pay high prices and French people pay lower prices." It's Americans pay higher drug prices because French people pay lower prices. (I'm not picking on France. It's everyone outside the U.S.)

I know some people will say this isn't true. I really don't care. I trust my source above every other human on Earth on this subject.

He also told me that large lots of AIDS drugs donated to health programs in Africa by his company were found on sale in pharmacies in ... sorry ... France. (Corrupt government officials in Africa sold the drugs and let their own people die.

This is only one of many factors. Many, many more circumstances drive up prices. All these things could change if government policy was correct. It's not. Voters, and the people they elect, need to get to work on this real issue and stop stirring up the crowds with the bonfire issues.

 

[abby99]

In other words, big pharma charges higher prices in the US because they can.

Is the market for not-yet-generic pharmaceuticals really a free market? A free market is "an economic market or system in which prices are based on competition among private businesses and not controlled by a government" (Merriam Webster). IMO, that last phrase should be "not controlled or protected by a government."

 

[DrStrange]

I agree with the basic premise that everyone should have access to health care even if they can't pay. But this is a very special case - very few end stage cancers are going to be "cured" and the costs are beyond shocking.

We are talking about numbers that shock the conscience. A million dollars per patient? Not for a cure but for a hundred extra days of life? Total costs for one drug comparable to the defense budget?? How are we going to pay for that? Can it make sense to spend 1% to 2% of GNP to pay for a single medical treatment that doesn't even cure a disease or have survivors?

And in the end this will be the question to answer. Does the government have an obligation to provide "free" healthcare to the elderly and poor even if it does actually bankrupt the nation.

DrStrange

 

[atomiktoaster]

I agree with the basic premise that everyone should have access to health care even if they can't pay. But this is a very special case - very few end stage cancers are going to be "cured" and the costs are beyond shocking.

We are talking about numbers that shock the conscience. A million dollars per patient? Not for a cure but for a hundred extra days of life? Total costs for one drug comparable to the defense budget?? How are we going to pay for that? Can it make sense to spend 1% to 2% of GNP to pay for a single medical treatment that doesn't even cure a disease or have survivors?

And in the end this will be the question to answer. Does the government have an obligation to provide "free" healthcare to the elderly and poor even if it does actually bankrupt the nation.

DrStrange

At least in this case, it's one the first of a whole new class of drugs and the profits might actually go towards new and better treatments. Hiking prices on existing drugs in short supply is worse, IMO. I'm not convinced that the average price would stay so high if the number of prescriptions grew to the maximum theoretical level (though some more efforts to ensure it doesn't would be great).

 

[Ben]

I expect this will be a transient problem - ENIAC was the size of an average-sized house and cost $400,000 to build in the 1940s (equivalent to about $5m in 2015 dollars,) and did next to nothing by today's standards.

Today we have a drug proven to extend the life of terminal cancer patients, even if only marginally, and the cost is exorbitant (as one might expect) - how many billions have been invested in cancer research to this point, with virtually no marketable results before now??? In a few more years there will be a new version that can perhaps extend life for a year, and cost a bit less (but still well out of reach for most people.) Then 2 years, and so on, and so forth, and maybe 70 years from now, all that will be required is a $10 shot for newborns and all cancers will be a thing of the past.

In the meantime, governments will have no practical choice but to turn to full-on global socialism, because capitalism and the free market are all well and great until you reach the point where the "free market" decides who lives and who dies - the global chaos resulting from that would be staggering. Say we reach the point in 30 years where, if you get cancer, you can be cured completely for the low, low cost of $10 million - what would YOU do to get your hands on that $10 million? What if were for your wife, or your child? What levels of crimes would you commit to save their lives???

We're headed towards a socialist state and in a more long-term sense, a socialist world anyway. One can only *hope* that it plays out like that (and I'm pretty much a hardcore libertarian - but you gotta draw the line somewhere.)

 

[DrStrange]

The cost curve for computing doesn't look anything like the cost curve for medication - though it would be really good for our wellbeing if it did. We spent 24 billion dollars (inflation adjusted) on prescription medication in 1960 and spent 371 billion in 2014. There were 180 million Americans then and 319 million now, so $133 per person in 1960 and $1,163 in 2014. (constant 2014 dollars)

There is no doubt that medicine today gets better results than in 1960. The performance curve for prescription medicine isn't anything as robust as the comparable tech curve is but that isn't unexpected. I think it is reasonable to say advances in medical technology have been impressive enough even if not as remarkable as the advances in computer technology.

However there is no evidence that the cost of medicine is falling. We aren't in a "Star Trek" world where the doctor drops off a pill for free and you grow a new kidney. There are lots of nice new treatments, but it isn't cheap nor is it about to get cheap. Remember, the free market price of miracle medicine is all you own and all you can borrow. A dying person is not generally able to negotiate for a lower price.

(For that matter, most patients for any medical procedure are in no position to negotiate. I offered to negotiate a cash-in-advance price with my wife's doctor a month prior to a scheduled surgery and got told with a sneer that the doctor's office doesn't barter. Then, after I paid their asking price in advance and after the surgery, got an extra bill saying we owed 3x the original price due to a coding error. That still is not resolved - perhaps we'll end up in court, perhaps not.)

Bottom line is the market forces that drive the price of computing gear ever lower per unit of performance are not in play to cut the cost of prescription medication because the customer often has few or no options and the vendors are protected by patent law and import controls.

DrStrange

 

[Ben]

the vendors are protected by patent law and import controls.

Today they are. This is what I'm getting at; if a pharmaceutical company perfects a cure for cancer tomorrow and tries to charge $10m per person for it, suddenly "patent laws" as we know them will become an endangered species.

 

[QuiQuog]

Do you think people would start smoking like it was the 70's again if a cure for cancer were found? This should be a big enough motivator for big tobacco to invest their big dollars into research. It's like a match made in heaven. If they founded a cancer research lab and discovered a cure, I could see them giving the drugs away for a song to keep their smokers smoking. The rub is that they'd have to admit that they know that tobacco causes cancer.

 

[DrStrange]

Smoking also causes emphysema, heart failure and damages other organs.

DrStrange

 

[manamongkids]

id pay more for my dog to live longer than i would for myself to live longer