Thursday, May 5, 2011

Easy Health Care Savings?

This morning’s Health Matters column in CongressDaily discusses “some fairly simple and even relatively noncontroversial ways to achieve substantial savings.”  Most of the rest of the column focuses on a recent study finding that the relatively less expensive Avastin performed relatively equally to treat macular degeneration of the eyes when compared to the more expensive drug Lucentis.  The article therefore concludes that the results from this study could “save a quick $5.9 billion dollars for Medicare next year without cutting benefits.”

While it obviously makes sense for patients to choose the less expensive treatment, all other things being equal, frequently when it comes to medical innovations and treatments all things are NOT equal.  Some individual patients may not respond to certain therapies, or less expensive treatments may be ineffective for certain segments of the population.  Given ongoing advances in personalized medicine, the idea that “A is always better than B” may be a misguided premise – in many cases, the options available may not represent a simple binary choice between one option or another; in other cases, clear-cut research may not exist; in other cases, option A will work better for some patients, while option B will work better for others.  Moreover, even if all options were proved equal in this ONE case (i.e., Avastin vs. Lucentis), it would be dangerous to infer from this one example that Medicare or other federal programs can determine the most effective treatment in ALL cases – because such an implication could lead to government-imposed rationing in cases where the evidence base, or the difference between treatment options, is much less clear cut.

Innovation has brought about dramatic benefits in life and health for millions of Americans in recent decades – and research into the best uses for these innovations can deliver powerful information to patients.  However, using that research to determine government coverage policies, no matter how well intended, could have significant costs for patients, over and above the potential savings for the federal government.