catallaxy files

catallaxy in technical exile

How much is a month of cancer-ridden life worth?

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In a story headed ‘Cancer drug shame’ The Sunday Age launches into another of its little crusades. The ‘”shame” here lies with the Pharmaceutical Benefits Scheme, which hasn’t listed some expensive cancer drugs. Adding to its outrage, wealthy people are allowed to buy these drugs. The paper quotes a doctor:

The PBS was set up so that everyone could have access to drugs, not just the wealthy, Professor Zalcberg said. But the opposite had occurred. “That’s the ultimate irony. That’s the horrible situation that we face because the majority of the community can’t afford these drugs.”

But “the majority of the community can’t afford these drugs” can be taken two ways. For example Avastin, for bowel cancer sufferers, costs $4,500 a month. If Avastin goes on the PBS that’s a lot of money, especially when its effects are modest – increasing survival from 15 to 20 months. Is that a sensible use of taxpayer’s money, given that PBS spending is already increasing at a rapid rate? – contrary to Professor Zalcberg’s claim that “the increase in the PBS cost to the community was less than inflation” Australian Institute of Health and Welfare data shows that it increased in real terms by an average of 13% a year between 1997-98 and 2002-03. And is enduring 5 more months of bowel cancer really among the unfair advantages of being relatively wealthy?

The whole area of end-of-life medicine is laden with dilemmas. Personally, I register every advance in this field with dread, as the chances increase that the pain and misery of my last few months (or, spare me, years) will be stretched out even further. But other people are determined to live every minute they can, no matter what the suffering and loss of dignity. Should the decision to prolong the life of the terminally ill be treated as an idiosyncratic one, not to be stopped, but not to be encouraged by subsidy either? That people have a right to spend their own money on it, but not taxpayer money that could be used on people who have a reasonable numbers of years in front of them? While I am inclined to think that drugs that give only 5 more months of life aren’t worth subsidising, what if it was 18 months of reasonable life quality? I really don’t know what my call on that would be – but contrary to The Sunday Age headline, these issues are real, and not a simple case of “shame”.

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Written by Admin

April 23, 2006 at 12:38 pm

Posted in Uncategorized

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