Costly Drugs Force Life-Death Decisions

Bottles of pills line the counter of Rebecca Dague's kitchen in Medina, Ohio, in this May 17, 2006 file photo. Dague takes an array of supplements in addition to the expensive drug, Erbitux, to treat her colon cancer. (AP Photo/Mark Duncan, File) (Mark Duncan - AP)

Heart pumps were first used as a temporary bridge to a heart transplant and only approved as regular implants in 2003. About 1,000 were implanted last year, but the ultimate annual market is estimated in the tens of thousands. Yet an analysis last year put their cost-effectiveness at between $500,000 and $1.4 million per year.

Even one of their pioneers, Dr. Eric Rose at Columbia University, concedes that would make their value "more than challengeable," but he expects improvements.

"It's hard for me to justify in a society that's falling short in basic health care," adds heart doctor Steven Nissen, at the Cleveland Clinic, a federal adviser who voted against expanding use of heart pumps beyond patients waiting for a transplant.

Dr. Barry Straube, who heads the Medicare unit that decides what to cover, believes "it would be helpful in setting priorities when we have limited budgets to look at cost-effectiveness."

Take also the example of the new biotech drug Avastin, which treats colon cancer for about $4,400 a month. Effectiveness? It is proven to extend average life by up to five months. In a survey this year, only one-fourth of 139 cancer doctors felt that represents "good value."

Genentech, which makes Avastin, believes its drug prices provide reasonable value to patients and powerful financial motivation in-house to improve treatments for a terrible disease, says Walter Moore, a company vice president. However, he says Genentech may impose its own lifetime cap on a patient's charges for Avastin.

For now, many hospitals partner with drug companies to treat dying patients for free, especially in the early stages of testing. Dr. Roy Herbst, at the M.D. Anderson Cancer Center in Houston, says the price of biotech drugs has forced the subject of cost into his discussions with colleagues for the first time.

"If we lost $30 million a year on Avastin, those are things that couldn't go into research and support programs," he says.

Others, too, question the current priorities of U.S. medicine.

"We've prioritized end-of-life care as more important than preventive care or chronic care," says Dr. John Santa, medical director for the Center for Evidence-based Policy in Portland, Ore.

Doctors, says University of Pennsylvania heart surgeon Dr. Michael Acker, should keep away from "high-tech, expensive technology just to postpone the inevitable."

"In the highest-benefit patient, you don't get that much benefit, and it costs a lot," adds Alan Garber, a Stanford University doctor and economist who chairs a Medicare coverage advisory panel and questions the value of both heart pumps and Erbitux.

Carolyn Hobbs' husband disagrees, at least in her case.

Though she initially refused Erbitux because of cost, she ultimately arranged to get that drug and three other biotech drugs for free, with help from her doctor, hospital, Medicare and the drug industry. Her husband says she managed to keep a reasonable quality of life, even through most of her final months.

She died in November. To this day, her husband isn't quite sure how much was spent.

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EDITOR'S NOTE _ Jeff Donn often covers medicine as the AP's Northeast writer, based in Boston.