Government

M4A and Keytruda

You have probably seen the adds. With Keytruda there is a chance to live longer. But how much longer?

Among patients whose PD-L1 levels were from 1% to 19%, those who got Keytruda lived for a median of 16.7 months after diagnoses while those who got chemotherapy lived a median of 12.8 months.

Among patients with PD-L1 levels from 20% to 49%, those who got Keytruda lived a median of 17.7 months compared with 13 months for patients on chemotherapy.

Patients whose PD-L1 levels were above 50% — those for whom Keytruda already has the FDA’s blessing — survived a median of 20 months with Keytruda, compared with 12.2 months for chemotherapy.

NOTE: Numbers vary by the type of cancer being treated, some are longer than above.

The cost of Keytruda for one year is $150,000. Is living four to eight months longer worth $150,000? If you are the patient no doubt it is.

But the real question is would a government agency tasked with evaluating the cost/benefit of health care treatment and managing costs arrive at the same conclusion? Not always.

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6 replies »

  1. It truly depends on the situation. Sometimes it allows science to find another solution. My experience was with a 42 year old daughter in the prime of her life. She/we did do everything possible to gain a chance to extend the timeline to try to find a ‘cure’. Unfortunately time was not on our side. Research and development have come a long way in the last 10+ years. Everyone should be allowed to make the choice that is right for them. How do you put a ‘price’ on a life?

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    • You raise a very human point, but the thing is society or the group of people in the insurance pool are paying the cost, not the patient or even the family. Who has the right to make the decision? In many other countries that decision is up to the government health plan.

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    • First like me say I am sorry for your loss. Every decision is unique and personal and please do not let my views be interpreted negatively about your family’s decision. I am sure your family did what is right for your daughter. No one decision fits all and I would never want some government bureaucrat or an insurance administrator to be the one making those decision based strictly from costs.

      Now I don’t have the answers but only the questions. Your decision involves more of a moral question versus a price or cost question or limitation. Should there be no limits in healthcare spending to prolong life? I use the term “prolong” to differentiate from sudden trauma or a heart attack, which over time as you have pointed out, science has found “cures” and people will return to contribute to society.

      Let’s take a less personal approach and put a premature baby in a NICU. The question is how much should we, as in society, spend on that baby. I say all of us because our insurance and even the government will pick up the bill as it starts to run into the hundreds of thousands of dollars because young couples usually do not have the means to pay that kind of bill.

      The moral answer is whatever it costs. What if that baby is the next Albert Einstein or would have found the cure for cancer? Nobody what to argue it any other way. Nobody wants to look into the face of a young mother and tell her that her baby is not worth the money.

      Now, what if a NICU stay averaged a billion dollars and a hospital’s NICU sees 25 babies a year? What if only 10% of those babies live to adulthood. What would that cost do to your health insurance premiums? How much will government taxes have to go up to cover the cost of those 25 babies? Will the hospital go bankrupt and now there is no NICU for anybody? Would you have to set a cost limit and let some die so others may live by still having a NICU? Is it immoral to spend all the money on just one baby when several babies can be saved in place of just one?

      If you apply the same thought process to a 90-year-old needing a hip replacement that already has three or four other chronic conditions, from a cost prospective you may say it doesn’t make sense. From a moral point of view, is it immoral to put a 90-year-old through the pain of an operation. Is it immoral not to try to operate. Of course, the true decision should be what the 90-year-old wants to do and nobody else’s.

      I can see myself as that new parent with a child in a NICU not caring what the costs are even if I ended up living in a cardboard box. But as an aging adult, I have decided for myself and thankfully, my wife shares my views, that even at age 56, we have lived full lives, and we are not willing to have excessive medical treatments to “prolong” our lives. When the time comes we may not even recognize the difference between prolonging treatments and cure treatments because of how doctors keep pushing treatments. Doctors feel that they must do something.

      I can only speak for myself on what I want. But society needs to have that conversation about the moral requirement to treat versus the cost of treatment. During last election cycle, the democrats called them death panels and that stopped the conversation. But interesting enough several states now allow assisted suicide. I still think that how much to spend on some treatments needs to be discussed because as more people think about what they want before the point of emotional decision in a hospital, it will be the first step in controlling costs or cause new ways to pay for “prolonging” life procedures. A panel should never get to decide which treatments should be done.

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  2. My sister’s mother in law is 92 and had her left cancerous breast removed. One stupid doctor wanted her to do chemo. A much smarter doctor was asked why would you give chemo to a 92 year old women? Answer – Only if you were trying to kill her. We all have to remember doctors have a license to practice medicine and they are practicing on us. Always get a second or even third opinion, there is way too much money involved to take the word of only one doctor.

    When or if we ever have M4A, the high cost treatments to extending life a few months will not be available, that may be the only good thing that will come from M4A. All the other negatives, high taxes, poor service, no real cost savings, will also be included as a result of M4A legislation.

    I have concluded this with a high school education and 62 years watching our government create more problems, than it has solved. Less government control of everything is what will MAGA. The only way you can still believe in the American Dream in 2018, is to be asleep!!!

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  3. I have questioned this before. $200K for an extra 4 months? They never state the quality of life for those 4 extra months either. My guess is that it takes a while to feel normal again after the chemo and surgery. You are going to feel very bad in your final month(s) no matter what. So what did you gain.

    Is your spouse now going to be bankrupt paying for this drug and the care that you require during those extra four months? Why isn’t natural allow to take its course.

    Assuming that the majority of these patients have already raised families before getting cancer, do they have that many regards that they think an extra 4 months will give them time to make peace on Earth and with their God? They were already being treated for cancer and should have made peace with their family so they shouldn’t need an extra 4 months.

    Or are the families being selfish and wanting their love one to live in pain so that they can visit them in hospice care once month? Big pharm is greedy and guilts you into believing that you should spend whatever it takes for every minute you have left on Earth. NEWSFLASH – life is terminal. I am all for a good fight, but I think this is one good case where I can support medical marijuana to ease the pain at the end for a fraction of the cost. There may also be a side effect that you now can relate with your grandkids or great-grandkids. Think of the stories you can tell them like: having only one land-line phone, 3 black & white TV channels, and taking personal responsibility. They will think you are really high and stay away from marijuana.

    Liked by 1 person

    • Dwayne, I always love to read your comments. I remember in the 1980s rural VA on vacation from Southern, CA, they still had party line phones, at a reduced cost over private lines.
      Some areas in TX did not get private lines until the 1990s. See my post above on how I feel about government intrusion into every aspect of our lives.

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