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Supply-driven medicine

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Austin Frakt flags a noteworthy study in the Archives of Internal Medicine that looks at who receives the most expensive care for prostate cancer. It had little to do with which treatment was better - and everything to do to with what kind of treatment patients lived closest to.

“No prostate cancer has been proven superior to the others,” the study notes. But there are significant differences in costs: Proton-beam therapy for the average 60-year-old man will cost $63,511. Radiation treatment’s price tag is nearly half that, at $36,808.

So who gets which treatment? This paper looked at about 19,000 men being treated for prostate cancer across California, and then looked at the availability of each treatment. What it found was those who lived closer to a facility with the more expensive proton-beam therapy were more likely to receive such treatment.

“To our knowledge, we show for the first time that the availability of a technology, in this instance a proton beam facility, in one’s HRR is associated with a higher likelihood of receiving proton beam therapy compared with those living in an HRR where this technology is not available,” the study concludes. “A single physician might explain the higher-than-expected rate of proton beam therapy in the Redding, California, HRR, since there are relatively low numbers of overall patients from this area.”

This isn’t exactly shocking news, that patients with easier access to more expensive treatments tend to use those therapies. It also likely speaks to some economic divides, with those in more affluent areas of California having easier access to proton beam treatment. It’s notable though, in that it highlights how much of our medical system is driven by supply: When new, more expensive treatments become available we start using them, even if there isn’t necessarily a noticeable improvement in health outcomes. Or, in the immortal words of Ray Kinsella, if you build it, they will come.

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