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Americans: don't weigh costs of new treatments

By Genevra Pittman

NEW YORK (Reuters Health) - Most Americans don't want the government to decide if medical treatments are economical before letting patients use them, a new survey suggests.

In some places, such as the UK and Germany, governments do have that power. Before patients can use a new drug, for instance, the government studies how well it works. It also sees what the drug costs compared to other drugs before deciding to make it available.

"The idea is to say, if we add this new technology, are we getting enough value for it given the increase in what we have to pay?" said Michael Botta. Botta led the study while in Harvard University's Program in Health Policy in Cambridge, Massachusetts.

"In those countries, I feel like it works pretty well," he told Reuters Health.

But in the new study, just 44 percent of Americans were in favor of doing something similar in the U.S.

Botta's team spoke by phone with roughly a thousand adults who were typical of Americans across the country.

They asked if people would support a government agency to study the costs and benefits of medical treatments. They also asked for opinions about four situations.

One, for example, involved a new drug for cancer. The drug lets people with cancer live a few months longer. But it costs $35,000 per patient.

In another case, one drug costs 100 times more than another. The expensive drug is proven to help treat a serious condition. The cheaper drug is not well tested, but many doctors use it because it seems to work. Here, people were asked how they'd feel if only the cheaper drug was available.

Along with their lack of enthusiasm for a U.S. agency, most people - between 61 and 73 percent - did not support decisions to limit a treatment's use or not provide it at all.

That surprised Botta. He expected people would not like the idea of a cost-effectiveness agency. Still, he thought more would understand the trade-offs that come with individual decisions.

But, he said, when people think of being sick, they don't care if a drug only adds a few months to the average patient's life. They think they themselves might get a larger benefit.

"I think most people in this country feel that if a treatment might help a person, then that treatment should be available to that person without considering the cost-effectiveness of that particular treatment," said Eugene Nelson. Nelson directs the population health measurement program at The Dartmouth Institute in Lebanon, New Hampshire.

Dr. Alec B. O'Connor, who has studied cost-effectiveness at the University of Rochester School of Medicine and Dentistry in New York, agreed.

"What I think is interesting about this is Americans seem to really focus on themselves as the patient," he told Reuters Health. But, he said, Americans don't seem to focus on themselves as the ones who are paying the bill.

Through insurance premiums and taxes, everyone is paying for other people's care, said O'Connor, who didn't work on the study.

"I think Americans would not feel like they should be paying huge amounts for small amounts of benefit in other people. People lose sight of the fact that they're paying for that."

What's more, he said, insurance companies already decide what they will and won't pay. It's just not always done in a rational way that considers cost and benefits.

‘GREATER BANG FOR THE BUCK'

Dr. Alvin Mushlin, who heads the department of public health at Weill Cornell Medical College in New York, said he was actually surprised by how many people were in favor of considering costs.

Mushlin, who wasn't involved in the new study, wonders if the results would be different if people knew what the savings could be used for. Helping pregnant women get prenatal care might be one use, for example.

The point of cost-effectiveness analysis "is not to save money," Mushlin told Reuters Health. The point "is to redirect the funds where you get even a greater bang for the buck," he said.

The new study, published in JAMA Internal Medicine, was funded by a grant from the pharmaceutical company Bayer.

Botta, who now works for a consulting firm, said governments usually pay for healthcare in countries with cost-effectiveness agencies. In the U.S., such an agency would probably only make decisions for what treatments are covered under Medicare, the government insurance program for the elderly and disabled.

He said rising healthcare costs are going to mean some treatments won't be feasible.

According to the Centers for Medicare & Medicaid Services, U.S. healthcare spending was $2.7 trillion in 2011. That comes to about $8,680 per person.

"We can't keep spending ever increasing amounts…on healthcare," Botta said. "This problem is not going away."

Still, he said, the findings suggest "it's going to be hard to find good solutions that people are willing to attempt to actually reduce the amount that we spend on healthcare."

Nelson, who didn't participate in the new study, said he thinks making certain treatments unavailable based on cost is now "politically unthinkable" in the U.S.

But there are other ways to curb health spending, he told Reuters Health. Those include getting rid of inefficiencies, preventing costly adverse events and promoting shared decision making between patients and doctors.

SOURCE: http://bit.ly/MbBLbb JAMA Internal Medicine, online October 7, 2013.

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