MEDICAL ECONOMICS

Linda and Viv Hailwood on a tough hike on Howgill Fell, Yorkshire Dales National Park.  About 1999.
                                  (She had a stream named after her on that hike:  Linda Beck.)

The review article I mentioned in my last post has a multitude of interesting things to say.  I just re-read the “box” on medical economics and was, as usual,  perplexed. 

I believe it was Senator Everett Dirksen who, in talking about a Federal budget of many years ago, said “a billion here, a billion there, and pretty soon you’re talking about real money.”  If he were alive today he’d probably say “trillion.”

Still Dirksen might have been impressed at the monetary cost that cancer inflicts on American society.  The estimate for 2002 was $171.6 billion, of which $60.9 billion were directs cost of medical care and the remainder the value of lost productivity.   I would bet the figure for 2012 would be close to twice that. 

I guess I shouldn’t have been surprised to learn that they actually do cost-effectiveness (CE) analysis on cancer screening strategies.  In comparing Strategy A to Strategy B (Strategy B could be no screening at all) one calculates CE = (Ca – Cb)/(LYa – LYb), where Ca is the cost of strategy A, LYa is the number of years of life saved using strategy A, etc.  A is judged to be superior to B if CE is less than $50,000.  I read this as a tacit estimate of the maximum value of a year of human life at $50K!  Note that nothing is said in this analysis about quality of life (QOL).

So why am I perplexed?  I guess it just rubs against the lay of my fur to put a monetary value on human life.  How much would I have paid to obtain another year of good life for Linda?  Everything I own.  But, how much would a year of life her life been worth if she had to live it as she was during her last two weeks?  Not much.  They need to factor QOL into their equations; don’t ask me how.

So, yes, I know that medical costs are out of control and we have to do something about it.  Maybe Cost-Benefit analysis has its uses.  That’s fine in the abstract – but when the life of someone you love is the subject, cost becomes irrelevant.

I’d be interested in some serious discussion of this issue.  Sorry this posting is so gloomy.