What Cost Cancer Treatment?

There has been a lot of excitement about Zelboraf, a new drug to treat metastatic melanoma. Since the previous standard of care was to try a bunch of futile chemotherapy and then die pretty much on schedule, this was a rather heartwarming breakthrough in a field that doesn't have enough of those.

Now Derek Lowe brings the bad news:

 

A bigger problem is that (as mentioned in my older post on this drug) resistant melanoma crops up pretty quickly after initial treatment with Zelboraf. Virtually all of the people taking the drug will eventually die of metastatic melanoma; it's just going to take longer. But how much longer, we don't know. The numbers still aren't quite in on overall survival - it's going to be more than the previous standard of care, but it's probably not going to be overwhelmingly more. Of course, the definition of "more" and the value that an individual patient places on it (or an insurance company places on it), well, those are the very things that keep us arguing about health care. Maybe that MEK co-therapy will make it an easier call?

I think the central difference between me, and the people who think that IPAB's reimbursement-rate powers will be a big help in controlling health care costs, is that the latter group tends to think that a lot of expensive health care problems are like back surgery--something that doesn't do any good, but gets done anyway, because of desperate patients and arrogant/ignorant/greedy surgeons. I tend to think that more of the questions are like this one.  Is spending $50,000 to give a pancreatic cancer patient an extra 5-9 months of life a wasted expenditure, or a medical advance? On the one hand, 5-9 months isn't very long.  On the other hand, for a typical pancreatic cancer patient, you've doubled their lifespan, which seems like  a very long time indeed.

If we get better cancer treatments--which is what everyone says they want--we're probably going to be asking those questions a lot.  And either way, we aren't going to like the answer.