I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: News Articles => Topic started by: okarol on December 07, 2008, 12:33:06 AM
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December 04, 2008
NICE: Is this our future?
By Anna Bennett
The New York Times ran an article British Balance Gain Against the Cost of the Latest Drugs. It caught my eye, and as I read it chilled me to the bone. I felt as though I were reading our future, and from the POV of the article, it looks bleak. In these troubled economic times (officially now a recession) fighting for aggressive healthcare is quickly becoming a luxury, and even more lives will be lost due to budget and service cuts.
From the article (the bolding is my emphasis):
For years, Britain was almost alone in using evidence of cost-effectiveness to decide what to pay for. But skyrocketing prices for drugs and medical devices have led a growing number of countries to ask the hardest of questions: How much is life worth? For many, NICE has the answer.
Top health officials in Austria, Brazil, Colombia and Thailand said in interviews that NICE now strongly influences their policies.
“All the middle-income countries — in Eastern Europe, Central and South America, the Middle East and all over Asia — are aware of NICE and are thinking about setting up something similar,” said Dr. Andreas Seiter, a senior health specialist at the World Bank.
Even in the United States, rising costs have led some in Congress to propose an institute that would compare the effectiveness of new medical technologies, although the proposals so far would not allow for price considerations. At the present rate of growth, medical costs will increase to 25 percent of the nation’s gross domestic product in 2025 from 16 percent, with half of the increase coming from new drugs and devices, according to the Congressional Budget Office.
To arrest this trend, the United States needs to adopt at least some of NICE’s methods, said Dr. Mark McClellan and Dr. Sean Tunis, who served earlier in the Bush administration as, respectively, administrator and chief medical officer of the Center for Medicare and Medicaid Services. Dr. Tunis said he spent a lot of time in government “learning about NICE and trying to adopt the processes and mechanisms they used, and we just couldn’t.”
That’s because the idea of using price to determine which drugs or devices Medicare or Medicaid provides has provoked fierce protests. But Dr. McClellan said the American government would soon have no choice.
Drug and device makers, which once routinely denounced the British for questioning product prices, have begun quietly slashing prices in Britain to gain NICE’s coveted approval, especially because other nations are following the institute’s lead. Companies have said that they will consult with NICE to help determine which experimental compounds enter the final stage of clinical trials, so the British agency’s officials will soon influence which drugs enter the market in the United States.
The British government created NICE a decade ago to ensure that every pound spent buys as many years of good-quality life as possible, but the agency is increasingly rejecting expensive treatments. The denials have led to debate over what is to blame: company prices or the health institute’s math.
Are we, the United States poised to have an even more bifurcated healthcare system, where if you are rich, you can afford the best possible dialysis, but if you are middle class or poor, you will suffer in center due to budgetary constraints? Will our government be forced to put a price on our lives and livelihood? It is terrifying to know that the technology to maximize our health is out there, but cost prohibitive for most. Is this what Dr. Chertow was getting at when he denounced a widespead change to more frequent diaysis?
No matter what happens in this economy, people are still going to come down with CKD. The stress of the recession may even add to hypertension that can cause CKD - so it is extremely possible that even more kidneys will fail.
I hope that Senator Dashle and his new Health and Human Services administration can navigate these times in a way that will provide maximum care for those with CKD5, and preventative care and screening for those early in their CKD journey. But if we follow the economic blueprint ofthe NHS, it will be basic medical care and each looking out for their own - no longer a case of physician heal thyself - but a case of individual educate thyself, heal theyself and find a way to pay for thyself or die.
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/12/nice-is-this-our-future.html
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I see the writing on the wall. Dialysis will have to be one of the first Medical procedures cut back. I think there are a lot of people on dialysis who shouldn't be. People being carried in on a stretcher not knowing even where they are. As long as people have a pulse Medicare pays these clinics. We just can't afford this as taxpayers. Medicare is going to have to look at where to cut costs. Dialysis is a huge expense.
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Many IHD members are in countries that have publicly-funded universal health care. I wonder what their perspectives on this issue are from personal experience in their own healthcare system.
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It is not that basic care will be cut. From what I have read, they are not recommending the "extras" Dr. Chertow from Stanford does not see any reason for rolling out in center frequent dialysis (in center nocturnal) as it is not cost effective. And medicare just needs an esteemed professional to advise them how to save money, and the cuts will start happening.
Home hemo (NxStage) is not offered in England. Very few people in Britain have the big expensive home hemo machines. Most are pushed for PD if they want home dialysis. Others can opine as to their experience with the NHS. Again, basic care is being administered - but how many people are able to work full time and dialyize? Or travel with their family? Or sail off the coast? We have the technology to feel better, and if the future is anything like the above, people with CKD5 on dialysis will be considered disabled, a burden on society, and will never klnow that more frequent dialysis can make you healthier, have more energy and give you a portion of your life back.
I wish that our Dr's and politicians would look to Australia for guidance, they have a robust program that promotes health that exists in a socialized medicine setting. It is sad that for those of us who desire maximum health - it just may not be economically feasible.
The tragedy is that these are DOCTORS making these recommendations. All of the progress that high dose dialysis and nocturnal have offered us are being reconsidered due to cost.
Here is a quote from a recent article (the bolding is my emphasis): http://ndt.oxfordjournals.org/cgi/content/full/gfn680
Some would also argue that even if the cost-effectiveness is not very good, we are dealing here with people's lives. In other words: ‘are we going to deny better care to these people for the reason of cost?’ I would rather talk about value than about cost. The real question is what is the value of this intensified care? Is it value for money? After all, the goal of health care is to produce health [3], and in any production process, one needs to aim for being productive, i.e. to produce the most possible output (here health) with the invested money. When a given production process is not productive, then we must not undertake it, because we spend money that could have been better spent elsewhere. In other words, proceeding with such not cost-effective care means denying better health care to other patients and to society.