The financial cost of saving a life: should it matter?

hfallada

In economics there is the term opportunity cost, which is the cost of a item not in financial costs, but in terms of the item foregone. Although €400k for a life may seem reasonable for some to save a life. €400k could probably hire about 10 extra nurses, which would improve the lives of hundreds of patients. Where as the cancer drug will only directly improve the life of one person.

If we used all the "miracle drugs " on the market, we would have an extremely drug bills with a minimal improvement to life. HSE not willing to write blank cheques to drug companies for these drugs, as their success is quite limited. There is only such much in the healthcare budget. We can give everyone miracle drugs, but staff numbers will have to be reduced or we will have to start paying more taxes. Sometimes people have to die, for everyone to have a higher standard of care

whupdedo

Deleted User wrote: »

He is 33 only. So not paid so many taxes.

Meanwhile, scum with multiple convictions and never having worked a day in their life get medical cards, social welfare and remain safe in the knowledge the idiot taxpayers will take care of them if anything bad should happen to them

steddyeddy

You get into dangerous territory when you start talking about who deserves health care more.

conorh91

Deleted User wrote: »

He is 33 only. So not paid so many taxes.

I didn't say whether or not it was a lot. I don't know what he earns, but it obviously isnt 400k.

The point is that he has done everything asked of him like a responsible citizen.

Anyway this is beside the point. Most people with intellectual disabilities are not taxpayers in any meaningful sense of the word, but we wouldn't countenance witholding medical treatment from them on that basis.

Waerobic Woxajack

This is a perfect example of the uncaring, atheist society we live in. Healthcare is not a luxury and ideally should be free funded by tax. Failing that, it should be cheap. It is up to a society to do this. Obscene salaries can be paid to ordinary penpushers in the HSE and elsewhere and 33 trillion can be provided for an evil war in Iraq. So, the leaders of our world should get their priorities right and do the decent thing and save lives.

mikom

Waerobic Woxajack wrote: »

This is a perfect example of the uncaring, atheist society we live in. Healthcare is not a luxury and ideally should be free funded by tax. Failing that, it should be cheap. It is up to a society to do this. Obscene salaries can be paid to ordinary penpushers in the HSE and elsewhere and 33 trillion can be provided for an evil war in Iraq. So, the leaders of our world should get their priorities right and do the decent thing and save lives.

Waerobic Woxajack wrote: »

This cruel and atheistic show that has no love for and makes fun of participants should not be supported. Making entertainment out of people's upset is no better than what terrorists do.

Waerobic Woxajack wrote: »

No, I never ever watched a full 'Late Late Show' in my life. It is, along with 'The Voice of Ireland' and all the other reality TV shows that hurt people, the very essence of all that is wrong in Ireland: a breed of atheism that is non-caring, corrupt, self serving and rude.[

Waerobic Woxajack wrote: »

The Late Late Show is an atheistic, capitalistic propaganda tool piping into our houses

Book yourself into the nearest nuthouse, there's a g'lad.

Waerobic Woxajack

mikom wrote: »

Book yourself into the nearest nuthouse, there's a g'lad.

I do not need to. Those who support wars that have killed millions, TV shows that mock and make fun of people and who are non-caring when it comes to the ill do need to however.

One eyed Jack

whupdedo wrote: »

That's true, but it shouldn't come into it, he has the same right to life as anyone with a medical condition that would be fatal without medical intervention, how much does cancer cost this country annually ?

Or if we're going down the road of medical costs, what about alcoholics who need a liver transplant ? or the alcoholic or heroin addict who needs treatment that's paid for by the state, These people have a choice not to drink or do drugs, but we don't let them die because they are a drain on the state

400000 a year is a paltry sum in a country such as Ireland to keep a man alive, and if that man can work and be a productive member of society after treatment, well better again,

how much money do we waste every year on life long dole scroungers, inept civil servant spongers and extortionate state pensions to undeserving politicians

If we let this man die for the sake of 400000 miserable grand a year we may as well bring in collective euthanasia for the terminally ill, anyone over 80 and the mentally retarded, that would save us billions in the long term

€400k every year to prolong the life of a man who has a terminal illness?

I empathise with the man and his family, but there's no way in hell to justify those sort of costs to keep one person alive for another few years.


€400k per year is neither miserable, nor paltry, unless you have no concept of economics, which, reading the rest of your post, indicates that you don't.

Karl Stein

The government granted monopoly (patent) on medicine is the problem. Before the screaming TINA's arrive there are indeed alternative ways of stimulating research.

Capt'n Midnight

conorh91 wrote: »

What do people think? Should life-saving drugs be denied if they cost too much? Can we put a price on life?

A very very rough rule of thumb is €40,000 per year for the remaining life expectancy.

steddyeddy wrote: »

You get into dangerous territory when youstart talking about who deserves health care more.

Since the health services have finite resources it's always been that way.

You can't save everyone so you have to maximise what you can do.

There's an argument that some people should be taken off live support if someone in A&E urgently needs one. I didn't catch the program but it was about premature babies needing long term care vs. those who would need it for a shorter time.



Drug companies typically send multiples of their R&D spend on marketing. And that's with the funnelling as much money into R&D as possible because of the tax writeoffs available. Some companies probably spend more on fines than on R&D.



At the other extereme
Keeping some people alive and in pain and letting other die early just because of differing health insurance is insane.

One eyed Jack

conorh91 wrote: »

I didn't say whether or not it was a lot. I don't know what he earns, but it obviously isnt 400k.

The point is that he has done everything asked of him like a responsible citizen.

Anyway this is beside the point. Most people with intellectual disabilities are not taxpayers in any meaningful sense of the word, but we wouldn't countenance witholding medical treatment from them on that basis.

Could you explain what you mean by "in any meaningful sense of the word", because as I understand it, "tax payer" is two words, and a person either pays tax, or they don't, and people with intellectual disabilities are quite capable of contributing to society, and paying taxes, and none of these people have ever cost the State €400k per annum, nor have they ever demanded that the State "fulfill it's side of the deal".

conorh91

Capt'n Midnight wrote: »

A very very rough rule of thumb is €40,000 per year for the remaining life expectancy.

where did you get that figure?

The idea of any kind of universal figure for all categories of drugs used in the treatment of serious illness regardless of cut-off ages seems ridiculous.

One eyed Jack wrote: »

Could you explain what you mean by "in any meaningful sense of the word", because as I understand it, "tax payer" is two words, and a person either pays tax, or they don't

Taxpayer is a single word. As far as I am aware, most people with intellectual disabilities do not work as employees, and thus do not pay tax in any meaningful sense of the word, i.e. make a net contribution after welfare transfers are accounted for.

whupdedo

One eyed Jack wrote: »

€400k every year to prolong the life of a man who has a terminal illness?

I empathise with the man and his family, but there's no way in hell to justify those sort of costs to keep one person alive for another few years.


€400k per year is neither miserable, nor paltry, unless you have no concept of economics, which, reading the rest of your post, indicates that you don't.

How would you feel if it was your child, spouse or parent, its not outside he bounds of possibilities.

I may not know much about economics, that's true I don't, but neither do I think it's right to let a cognitive, able human being die for the want me 400 grand a year, I must admit it surprises me if you think 400 grand is a lot of money, in the grand scheme of things its merely a pittance to a wealthy western civilised society, yes I did say wealthy!!!!

How much do we send out to African dictators to keep them in the lifestyle we have paid them to become accustomed to, how much do we spend on military intervention in places we have no business being.

If this young man dies because of a ****ty 400 grand a year, what next ? Letting mentally handicapped kids die, introducing pay caps for ill patients who are deemed too costly to try to save ? Hopefully not, and hopefully not to someone you love and care about

One eyed Jack

conorh91 wrote: »

Taxpayer is a single word. As far as I am aware, most people with intellectual disabilities do not work as employees, and thus do not pay tax in any meaningful sense of the word, i.e. make a net contribution after welfare transfers are accounted for.

That's fair enough, I can't argue with that, but I think it's important to stress that this isn't for the lack of wanting to gain employment. There are discriminatory factors there that are the greatest barrier to intellectually disabled people gaining employment that they could become one of those taxpayers you speak of in the meaningful sense of the word, and I think it's simply an unfair comparison to make between intellectually disabled people who want to work, and one taxpayer who feels the State should pay for their exorbitant medical costs.

conorh91

One eyed Jack wrote: »

it's simply an unfair comparison to make between intellectually disabled people who want to work, and one taxpayer who feels the State should pay for their exorbitant medical costs.

It wasn't a comparison. I was pointing out that a person's taxpaying history is not a salient factor when allocating life-saving medical resources.

I am very doubtful as to whether this case merits public money, but there is a distinct tone of blaming the ill man coming from your statement.

Just as the intellectually disabled might want to work, this man wants to be healthy. It isn't a lifestyle choice. He's doing what many of us would do in his situation. I doubt we'd all be reclining in our armchairs thinking "No, I will die before I become a burden on the Exchequer"

One eyed Jack

whupdedo wrote: »

How would you feel if it was your child, spouse or parent, its not outside he bounds of possibilities.

I've been there, my family member would never have survived a heart and lung transplant given their condition. There are some decisions where as hard as it is to accept them, we just have to. Reality can be cruel like that, and as much as you want to do for the person, sometimes it's just not feasible.

I may not know much about economics, that's true I don't, but neither do I think it's right to let a cognitive, able human being die for the want me 400 grand a year, I must admit it surprises me if you think 400 grand is a lot of money, in the grand scheme of things its merely a pittance to a wealthy western civilised society, yes I did say wealthy!!!!

€400k is a lot of money in any man's language, and even more so when it's going towards sustaining the life of a person who is terminally ill. That's even before you have to accept the reality that the HSE simply doesn't have that kind of money with hospital closures and people lying on trolleys in corridors for want of a hospital bed.

If this young man dies because of a ****ty 400 grand a year, what next ? Letting mentally handicapped kids die, introducing pay caps for ill patients who are deemed too costly to try to save ? Hopefully not, and hopefully not to someone you love and care about

It's not a shìtty €400k for a start, that money could be used to provide many more essential treatments for people who have a more realistic prospect of survival. The rest of that paragraph, people have to make decisions like that all the time. You're just not aware of them because they don't all cost €400k per year to keep them alive.

As far as I remember at the time, a heart and lung transplant would have cost €100k and was still a very experimental procedure. My brother made the choice for themselves and never expected the State to cover their medical costs.

One eyed Jack

conorh91 wrote: »

It wasn't a comparison. I was pointing out that a person's taxpaying history is not a salient factor when allocating life-saving medical resources.

I am very doubtful as to whether this case merits public money, but there is a distinct tone of blaming the ill man coming from your statement.

Just as the intellectually disabled might want to work, this man wants to be healthy. It isn't a lifestyle choice. He's doing what many of us would do in his situation. I doubt we'd all be reclining in our armchairs thinking "No, I will die before I become a burden on the Exchequer"

Not in so many words, no, but there are many people who favour euthanasia over prolonging their life if only to suffer in constant pain from their illness. I'm sure you're no doubt aware of the case of Marie Fleming.


Just reading up about this condition, and came across this -

However, just as many pharmaceuticals designed to treat rare diseases, eculizumab is controversial due to its high cost. Manufactured by Alexion Pharmaceuticals under the brand name Soliris, is among the most expensive pharmaceuticals in the world, with a price of US$440,000 per patient per year.[12] Because there is insufficient evidence to show that eculizumab therapy results in significant improvement in life expectancy, statistical calculations have shown poor cost-effectiveness. For example, a 2014 Canadian study calculated the cost per life-year-gained with treatment as CAD$4,618,561 (US $4571564) and cost per quality-adjusted-life-year as $2,134,156 (US $2,112,398).[13] New Zealand's government pharmaceutical buyer Pharmac declined a proposal to subsidize the drug in December 2013, after Alexion refused to budge on a NZ$670,000 (US$590,000) per patient per year price and Pharmac's economic analysis determined the price would need to be halved before the drug was cost-effective enough to subsidize.[14] Pharmac's decision upset many New Zealand PNH patients,[15] although Pharmac has not ruled out reviewing the decision at a later date, or funding it on a case-by-case basis under the Named Patient Pharmaceutical Assessment (NPPA) programme.[14]

http://en.m.wikipedia.org/wiki/Paroxysmal_nocturnal_hemoglobinuria

Wildlife Actor

One eyed Jack wrote: »

I've been there, my family member would never have survived a heart and lung transplant given their condition. There are some decisions where as hard as it is to accept them, we just have to. Reality can be cruel like that, and as much as you want to do for the person, sometimes it's just not feasible.

€400k is a lot of money in any man's language, and even more so when it's going towards sustaining the life of a person who is terminally ill. That's even before you have to accept the reality that the HSE simply doesn't have that kind of money with hospital closures and people lying on trolleys in corridors for want of a hospital bed.

It's not a shìtty €400k for a start, that money could be used to provide many more essential treatments for people who have a more realistic prospect of survival. The rest of that paragraph, people have to make decisions like that all the time. You're just not aware of them because they don't all cost €400k per year to keep them alive.

As far as I remember at the time, a heart and lung transplant would have cost €100k and was still a very experimental procedure. My brother made the choice for themselves and never expected the State to cover their medical costs.

There's your answer OP.

bnt

whupdedo wrote: »

How would you feel if it was your child, spouse or parent, its not outside he bounds of possibilities.

So? That argument applies to every person in the country. What if it was the child of the Health Minister - would you be in favour of special treatment then? Family connections should not get you any favours, that would be nepotism. That's why decisions of this sort should be made impartially, by people with no personal connections to those affected - otherwise you have the personal taking priority over the public.

lila1

God it would be terrible if that was happening to anyone my own family I was on medication costing 5,000 per month for about 3 years, but then had major brain surgery costing 60.000 sterling and was able to come off the medication, saving the hse money in the long run.

conorh91

One eyed Jack wrote: »

Not in so many words, no, but there are many people who favour euthanasia over prolonging their life if only to suffer in constant pain from their illness. I'm sure you're no doubt aware of the case of Marie Fleming.

Marie Fleming was pursuing her case in the interests of her own dignity, as opposed to altruistic concerns about the Exchequer. And rightly so.

Interestingly enough, her partner was recently arguing for the HSE to make drugs available to diminish some of the side-effects of her condition which, so far, the HSE has deemed unaffordable.

Mr. Incognito

There are ten people in Ireland with this disease so the argument that it would bankrupt the state to provide this for everyone is moot.

The treatment should be funded. The deal is terminal patients get free drugs.

Cost shouldnt be a factor.

Pay for the treatment HSE and shut the hell up.

conorh91

Mr. Incognito wrote: »

Cost shouldnt be a factor.

Anyone who says "cost shouldn't be a factor" is essentially saying that no notice should be taken of the sacrifices endured by others in paying that cost.

The people who pay the cost are other health service users in terms of funds being allocated away from them. Those of us in the fullness of our health who make such sweeping statements online suffer no net loss.

As I said earlier, I don't know whether this man should get the drug or not. But cost certainly is a factor, and a bloody important one.

Kurtosis

If you extend this argument to every patient in the country needing life-saving or life-sustaining treatment and say pay for them all, the health system would quickly be out of money. We live in a system with constrained resources and therefore have to consider cost-effectiveness as for everything that is funded, there is something else that could have been funded instead but has to be foregone.

In weighing up alternative options, the cost for each extra year of perfect quality life a treatment provides has to be considered. Although other factors are included in the decision making process, the value a treatment provides is majorly important.

Raging_Ninja

There's always been a price placed on a life. In the NHS, thats £30000* - if your treatment costs more than that, then you are depriving somebody else of their treatment. Its the same story here.

* http://www.ncbi.nlm.nih.gov/pubmed/18767894

stillalive88

400 THOUSANDS per year? Are we joking? Do they really want us to believe that it can get THAT expensive? The price is just made up!
What are they healing him with anyways, solid gold encrusted with diamonds?

Manach

Given that the cost of pre-natal care or that of the end of life treatment is so expensive (as per medical expert Robert George) that rather explains the certain aspects of government support of "choice" issues...

Earthhorse

It shouldn't, but it does.

I don't know enough about the specifics of how these decisions are made to know where the limit should lie though nor do I envy those in charge of making such decisions. Cases like these only highlight the need to eliminate wasteful spending and practises from organizations to free up money and save lives.

Donnielighto

It is not 400k, it is 400k a year and a precendent that the state will shell that amount yearly indefinitely. That level of care could be a pplied to thousands of people and would bankrupt the state if it happened. Unfortunately beyond general health staffing and overheads there is a budget for patient treatments and I think it is around 40k max per person for a single issue.

twowheelsonly

We pay close to 400k a year to keep Enda Kenny alive and 150k+ a year each to keep the likes of Bertie Ahern and Brian Cowen alive as it is so what's the difference!!!

Seriously though, the fault lies with Corporate greed. Alexion, the makers of the drug, are worth billions with over 3 billion in nett assets and over 2 billion in total equity. That suggests to me that the R & D is well paid for at this stage.
Estimates of the number of sufferers of this disease are between 10 and 21 thousand between USA and Europe so whilst rare they're not short of customers either considering that the drug is also used to treat another similar disease. IMO the drug could be manufactured and supplied at a far lower cost now but that might upset the shareholders.

Would I give it to this patient??
Absolutely, without a shadow of a doubt.

The long term figures are skewed in any case as once the patent runs out generic replacements will become available, IMO at probably far less than half the price.