Some of the most influential medical groups in the nation are recommending. through guidelines, that doctors weigh the costs, not just the effectiveness of treatments, as they make decisions about patient care. This is in response to the continuing, across the board rise in treatment costs. Traditionally, guidelines have heavily influenced the practice of medicine, and the latest ones are expected to make doctors more conscious of the economic consequences of their decisions even though there is no obligation to follow them. Medical society guidelines are also used by insurance companies to help determine reimbursement policies.
Medical groups, such as the American Society of Clinical Oncology, now recognize that cost of treatment is a factor worth considering in patient care. With some cancer drug treatments costing hundreds of thousands of dollars, the problem is present both on the patient level, and on a broader societal level. Generally, Medicare is not supposed to consider treatment cost in its decision making, while insurers do perform cost analyses, but risk the wrath of angry patients and doctors.
Some doctors, however, feel an obligation to safeguard the entire system by choosing cheaper treatment alternatives. Doctors can face some stark trade-offs. Studies have shown, for example, that two drugs are about equally effective in treating an eye disease, macular degeneration. But one costs $50 a dose and the other close to $2,000. Medicare could save hundreds of millions of dollars a year if everyone used the cheaper drug, Avastin, instead of the costlier one, Lucentis. However, the FDA has not approved Avastin for use in the eye for fear of an increased risk, albeit slight. How should doctors factor this into their decision making?
There is a sort of cost-benefit analysis being performed depending on the effectiveness of the treatment and its alternatives. The cardiology societies say that the idea that doctors should ignore costs is unrealistic because they already have to consider the financial burden placed on the patient, if not society. “Protecting patients from financial ruin is fundamental to the precept of â€˜do no harm,’ ” the societies wrote in their paper outlining the new policy. At the same time, Hepatitis C guidelines issued in January by the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America recommend the new drug Sovaldi with no mention of its $84,000 price tag.
As treatment costs continue to climb, these types of analyses will happen more often – whether it is by doctors, medical groups, or by patients who are concerned about financial distress.
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