NCPA - National Center for Policy Analysis


August 14, 2006

Is the chance for several more months of life -- maybe a year or more, with luck -- precious enough to spend a small fortune?  Extraordinary care for dying patients can make for inspiring medicine, but its extraordinary costs make it an increasingly debated choice in promoting public health, say observers.

Faced with a lethal disease, more than a third of Americans now would want everything possible done to save their lives, up from just over a fifth in 1990, according to a poll by the Pew Research Center for the People and the Press.

Yet this kind of care costs several times more than the older treatments it supplements or replaces:

  • A mechanical heart pump can cost more than $200,000, with hospital care.
  • A last-resort cancer drug can cost up to $50,000 a year -- if patients survive that long -- but insurance would typically pick up at least two-thirds.

Federal safety regulators evaluate only whether drugs or devices work, not how well they work for their prices.  And Medicare, which insures about 80 percent of dying Americans, makes no acknowledged evaluation of cost in deciding what to cover.  Its coverage umbrella sets a standard for private insurers, say observers.

  • Some insurers refuse to cover a treatment; doctors send patients home to die, sometimes out of mercy, and some patients say enough is enough.
  • One common approach calculates the cost of a treatment for each year of life it saves -- with an adjustment for suffering and side effects.
  • Many health economists view $50,000 to $100,000 as a reasonable upper limit.
  • Many hospitals also partner with drug companies to treat dying patients for free, especially in the early stages of testing, but even some doctors worry that too many patients merely spend, suffer and die.

Source: Jeff Donn, "Dying patients stretch funds to extend lives; New drugs, treatments can buy a few months, but the prices are steep," Associated Press/Kansas City Star, August 13, 2006.


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