I woke up on Independence Day morning to Dr. Isidore Rosenfeld’s segment on the Fox channel. He discussed, among other things, a new prostate cancer treatment from Dendreon Corporation. It jogged my memory about an article in Marketplace from 4/30/10 that I’d put aside describing this “therapeutic vaccine,” a new form of immunotherapy that could presage “a whole world of new therapies base on that concept across all cancers,” according to Dr. Kantoff, chief of solid tumor oncology at Dana Farber Cancer Institute in Boston. Good news, right? Well, in principle.

The new therapy costs $31,000 for each of three courses of treatment, for a total of $93,000. Like most treatments for late stage cancers, it extends life only a few months. Median survival increased to almost 29 months or about four months longer than control patients. The article goes on to say that “Mitchell Gold, Dendreon’s chief executive, said the federal Medicare program, which covers 70% to 75% of patients who would likely be eligible for the treatment, as well as insurers are aware of the pricing and he indicated he doesn’t expect coverage to be an issue.”

The concept of a cancer vaccine is outstanding and I hope further refinement improves this modality as a viable treatment alternative. The question is, can an already inefficient and overburdened system afford to divert almost $100,000 to extend a life expectancy of about 2 years for an additional four months?

It can be difficult to put a price on life, but the truth is cost effectiveness analysis is done routinely, as it must be, and influences treatment plans. Unfortunately, it’s done haphazardly and reluctantly. We can and must do better, and it will involve making intelligent and often difficult decisions on the best way to allocate limited resources. Because for each dollar spent for real but limited gains, someone else must do without.

And their life has worth too.


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