The Price of Life

Film maker Adam Wishart has made a wonderful documentary about healthcare prioritization that I think illustrates the issues very well.  It focuses on one decision by NICE, the National Institute for Clinical Excellence in the UK, about whether or not the UK healthcare system, the National Health Service (NHS), should fund Revlimid, a very expensive drug used to treat terminally ill patients with myeloma, a cancer of the blood.

It follows a number of patients with terminal myeloma, for whom this decision is literally life or death.  It interviews the developer of the drug, who argues that high drug prices are essential to encourage the innovation that leads to the next generation of lifesaving drugs.  Finally, it shows the dilemma faced by health system administrators who are responsible for allocating a budget between different groups of citizens and patients.  If this expensive drug is funded, it means that they will have to find the money to pay for it elsewhere in their budget.  If you’ve participated in my preferences survey, you’ll recognize their dilemma.

From my point-of-view, a key moment comes at the 48 minute mark of the film, where one of the decision makers expresses the essential truth of healthcare priority setting: if they fund this very expensive drug rather than funding less expensive treatments for patients with different conditions, it implies that an extra year of life lived by myeloma patients is worth more than an extra year of life lived by the other patients. This is the reality of “priority setting”: to give one group higher priority, you have to give another group lower priority.

As mentioned in the film, many people are unhappy with the QALY, or the quality-adjusted life year, as the basis for how these decisions are currently made.  It is assumed that society considers one additional QALY to be equally valuable to everyone, regardless of who gets it and how many they get.  But as the preliminary results of my survey show so far, that’s not how most people feel.  The overwhelming majority of respondents so far have been answering in ways that suggest they do care about who gets that additional QALY.  The objective of my research is to explore how we can make these decisions in a way that we all can agree with. 

I would be very curious to hear your thoughts on this documentary.  If you were the committee chairman at the end, how would you have voted?  Do you accept the need to deny some patients treatment, or is there a different solution where all patients can receive all beneficial treatments?