adaher
October 25, 2015, 4:47pm
37
Broomstick:
Yes, I’d be interested in knowing what treatments are unavailable under, say, the UK NHS that are readily available in the US.
Now, people might have to wait for non-emergency things… but that ain’t going to kill you. Sorry if you need to wait an extra two months to get your knee replaced.
There’s also the issue of profit motive in the US system leading to over-treatment, which brings its own pile of problems. There’s a couple of doctors in my area that are being dragged into court for performing unnecessary open-heart surgery on dozens of people who should not have been operated on. I think that sort of abuse-for-profit is less likely under a single-payer system.
Too much testing and over prescribing of drugs is definitely an issue, although that’s a tort problem as well as a profit motive problem. Single payer systems deal with that issue as well by not allowing big settlements. Tort reform and single payer go hand-in-hand.
As for treatments unavailable, NICE denies drugs all the time for failing to meet cost/benefit estimates base on quality life years remaining. Yes, a number is actually put on people’s lives.
NICE guidance supports the use of quality-adjusted life years (QALY) as the primary outcome for quantifying the expected health benefits associated with a given treatment regime. By comparing the present value (see discounting) of expected QALY flows with and without treatment, or relative to another treatment, the net/relative health benefit derived from such a treatment can be derived. When combined with the relative cost of treatment, this information can be used to estimate an incremental cost-effectiveness ratio (ICER), which is considered in relation to NICE’s threshold willingness-to-pay value.[24]
As a guideline rule, NICE accepts as cost-effective those interventions with an incremental cost-effectiveness ratio of less than £20,000 per QALY and that there should be increasingly strong reasons for accepting as cost-effective interventions with an incremental cost-effectiveness ratio of over a threshold of £30,000 per QALY.[26]
Over the years, there has been great controversy as to what value this threshold should be set at. Initially, there was no fixed number. But the appraisal teams created a consensus amount of about £30,000. However, in November 2008 Alan Johnson, the then Secretary of State, announced that for end-of-life cancer drugs the threshold could be increased above £30,000. [27]
The first drug to go through the new process was Lenalidomide. And its ICER was £43,800.[28]
NICE guidance supports the use of quality-adjusted life years (QALY) as the primary outcome for quantifying the expected health benefits associated with a given treatment regime. By comparing the present value (see discounting) of expected QALY flows with and without treatment, or relative to another treatment, the net/relative health benefit derived from such a treatment can be derived. When combined with the relative cost of treatment, this information can be used to estimate an incremental cos...
And an example of a drug refused:
Deborah Orr: The NHS watchdog, Nice, is being portayed as penny-pinching over its refusal to fund a hugely expensive new cancer drug. But shouldn't we be asking why its manufacturers want to charge so much?