Word: costes
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Placing a cap on drug costs could save U.S. health care billions. But it's not without controversy. England and Wales have set up a body called the National Institute for Health and Clinical Excellence (NICE) which reviews treatments to decide which are the most cost-effective and which the National Health Service (NHS) should pay for. A new drug has to offer value for money - and if it doesn't, whether it is life-saving or not, NICE won't approve...
...scale. A patient on the drug can expect to live an average of 15 years following the treatment. Taking the new drug thus earns patients the equivalent of three quality-adjusted life years (15 years multiplied by the .2 gain in quality of life). If the treatments costs $15,000, then the cost per quality-adjusted life year...
Taking its lead from Britain's Department of Transport - which has a cost- per-life-saved threshold for new road schemes of about $2.2 million per life, or around $45,000 per life year gained - NICE rarely approves a drug that costs more than $45,000 per Qaly (the fictitious drug would easily pass...
...only does the equation make hard-nosed sense in a public-health system, its use can reduce costs in other ways. Eager to gain NICE's approval, drug companies have started giving away portions of expensive treatment for free in Britain in order to ensure their drugs meet the threshold. Sir Michael Rawlins, chairman of NICE, believes that if the U.S. adopted a similar system, it would revolutionize the culture of major pharmaceutical companies, many of which spend more on marketing than research and development. A 2008 study in the New England Journal of Medicine predicted that incorporating information about...
Aware that the idea of "rationing" health care would prove controversial in the U.S., advocates of reform - from the American College of Physicians to the advocacy group Center for Medicine in the Public Interest - have suggested a system of review that doesn't take into account the cost of new treatments. This would help doctors decide a course of treatment, as currently they have no way of comparing the efficacy of different drugs for the same condition. But it could also raise prices. "In a free-market economy the manufacturers may use the effectiveness review to charge higher prices...