Guaranteed Or Your Money Back?
My friend Richard often sends me articles from the New York Times - I subscribe to the email headline notices and skip through those regularly, he subscribes to the "TimesSelect" option and actually reads the entire paper daily. So he picks up a lot that I miss.
One of his recent mailings was "Pricing Pills by the Results", which outlines industry thoughts on pricing expensive drugs based on efficacy. The lead example is Johnson & Johnson's proposal that the national health service in Britain pay for Velcade, a cancer drug ($48,000 per patient), but only for those whose tumors actually shrink; monies for other patients would be refunded.
It's an interesting concept, but I wonder how the details would be worked out. What constitutes shrinkage, for example (thirty percent, ten percent, seventy percent, or "all or nothing"), and who determines the definition of success (the drug company, the patient/oncologist team, or the purchaser)?
Is shrinkage the only goal? As we move further and further toward redefining cancer as a chronic illness, managing the disease rather than "curing" it, shrinkage seems to be less dominant in the discussion. I haven't seen any shrinkage for over a year now, yet my disease is well managed and my quality of life is good. I'm more comfortable now than I've been since fall of 2003 when my metastases were discovered, and I appreciate the stability. Shrinkage is a wonderful thing when it happens, but it isn't the only measure of patient response. Having nearly died while taking a drug that was shrinking my lesions at a spectacular rate, I'll take maintenance as the best response.
I can see pharmas pushing for relaxed definitions of success, to ensure the greatest possible rate of payment, and purchasers pushing for stringent definitions of success, to limit the number of payouts required. At what point does the struggle to define the bottom line, also define when and how the drug will be administered? What happens if one elects to remain on a drug even though results might not be "guaranteed"?
I hope that patients have a voice in the decision.
One of his recent mailings was "Pricing Pills by the Results", which outlines industry thoughts on pricing expensive drugs based on efficacy. The lead example is Johnson & Johnson's proposal that the national health service in Britain pay for Velcade, a cancer drug ($48,000 per patient), but only for those whose tumors actually shrink; monies for other patients would be refunded.
It's an interesting concept, but I wonder how the details would be worked out. What constitutes shrinkage, for example (thirty percent, ten percent, seventy percent, or "all or nothing"), and who determines the definition of success (the drug company, the patient/oncologist team, or the purchaser)?
Is shrinkage the only goal? As we move further and further toward redefining cancer as a chronic illness, managing the disease rather than "curing" it, shrinkage seems to be less dominant in the discussion. I haven't seen any shrinkage for over a year now, yet my disease is well managed and my quality of life is good. I'm more comfortable now than I've been since fall of 2003 when my metastases were discovered, and I appreciate the stability. Shrinkage is a wonderful thing when it happens, but it isn't the only measure of patient response. Having nearly died while taking a drug that was shrinking my lesions at a spectacular rate, I'll take maintenance as the best response.
I can see pharmas pushing for relaxed definitions of success, to ensure the greatest possible rate of payment, and purchasers pushing for stringent definitions of success, to limit the number of payouts required. At what point does the struggle to define the bottom line, also define when and how the drug will be administered? What happens if one elects to remain on a drug even though results might not be "guaranteed"?
I hope that patients have a voice in the decision.
Labels: in the news, maintenance costs, medications
posted by rcclive at
12:02 PM
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