The Supreme Court decision issued today means that the Affordable Care Act (ACA) is not derailed, and 6.5 million Americans do not drop off the benefit rolls. This is certainly good and helpful news but does not alter the fact that our healthcare system is still in crisis mode. The continued rising costs of cancer drugs—the focus of several recent publications—one by the American Society of Clinical Oncology(ASCO,) commented upon in the New York Times by Andrew Pollack, and the other by a team from the University of Texas MD Anderson Cancer Center, which have been critically evaluating the justification for higher drug costs. Complex formulae are being used to create a “value framework,” which serves only to make it harder and harder to both understand what is going on and to come up with sensible answers.
One number that keeps coming up in the calculations is the dollar value of human life for one year: currently listed at $50 – $100,000, with $50,000 being the number listed in most studies. So what does this very harsh statistic mean? It is the focus of the review system called “NICE” in the UK (National Institute for Care and Excellence), in which the cost of cancer treatment is weighed against the idea that cancer patients could get back to work with the quality of life sufficient to contribute $50,000 annually to the economy. For me, this is truly extraordinary! Is our moral compass completely shattered? Do you need to have the ability to go back to work to be worthy of treatment?
I feel like we need to have “Mr. Smith Goes Back to Washington” and do some simple math. If, as indicated by ASCO, Velcade costs approximately $7,000/month as part of triple therapy (VMP was used as a model versus MP, which costs $279/month), how does that fit into the family budget? The simple answer is that an extra $5,000 - $10,000/month expenditure does not fit into anyone’s family budget. It is “covered by insurance” is the pat answer. But, health insurance is starting to look like Lloyd’s of London which insure ships at sea. When all the ships go down, it is a problem!
The cost of medical care is no longer an episodic thing. It is an ongoing cost. And there are all kinds of rising costs, ranging from establishing electronic record systems (hugely expensive, costing billions of dollars) to diagnostics such as new scans and imaging (MRI, PET/CT, etc.) to the costs of novel therapies and stem cell transplants. I could go on.
The issue is that ultimately the costs have to be realistic or the system just breaks, as it has broken right now. Money has to come from somewhere. Mr. Smith needs to be able to add up the family budget on the backside of an envelope and still be on the positive side.
Bringing everyone to the table is the only way forward. My requirement is that we put the moral compass back in the center of the table. Health is not a luxury. It is what is provided to citizens in a civilized society. We have the ability to do research, come up with new treatments, and have patients get the treatment they need and leave the table happy – but with everyone giving something so that the budget on the back of the envelope can be balanced.
Will this be easy? No! I realize that these days Mr. Smith would have to juggle quite a few envelopes. One envelope would say “healthcare,” but others would say perhaps “climate change costs” or “the costs of taking trans fats out of the diet,” which, according to New York Times editorial writer Mark Bittman, will cost the “food industry” $6 billion per year. So the “food industry” is given a three-year reprieve. There are so many issues to grapple with.
But the IMF and the International Myeloma Working Group (IMWG) are committed to moving forward on this issue. The topic was the focus of several discussions at the recent IMWG Summit in Vienna and follow-up meetings are planned for this year.
So stay tuned! We are committed to making progress in this area.
Dr. Brian G.M. Durie serves as Chairman of the International Myeloma Foundation and serves on its Scientific Advisory Board. Additionally, he is Chairman of the IMF's International Myeloma Working Group, a consortium of nearly 200 myeloma experts from around the world. Dr. Durie also leads the IMF’s Black Swan Research Initiative®.