Cancer drug advances debate on life's value

How much is life worth? How do you put a value on a few months more? As uncomfortable as those questions are, America is going to have to find an answer, and soon.

Medicine has long been seen - by both patients and doctors - as an endeavor above base commerce, above such things as cost-benefit analyses or profit margins. Which is not to say that doctors have toiled in poverty; but the goal of medicine has been to keep people healthy, no matter the cost.

The nation can't afford that anymore. Medical costs are now 16 percent of America's total gross domestic product, requiring $7,600 in spending for every man, woman and child. Insurance premiums are rising at twice the rate of inflation; by 2016, according to the National Coalition on Health Care, medicine will consume 20 percent of the GDP, as baby boomers begin aging in earnest.

Blame the inexorable rise in the amount of medical care Americans consume, in the form of more testing, more procedures and - perhaps especially - more drugs.

Genentech's anti-cancer drug Avastin was the subject of a recent story in The New York Times, not for how well it works for the $100,000 it can cost a year, but for how relatively little it does.

The newspaper reports that Avastin is one of the most popular anti-cancer drugs on the planet - racking up $3.5 billion in sales last year - despite extending "life by only a few months, if that."

A month means more at the end than it does at the beginning of life, but doctors and thinkers are beginning to ponder whether Avastin and similar drugs are, put plainly, worth the cost: Is $100,000 too much to pay for a few more months of life?

Avastin is in a promising class of drugs that works by cutting off blood to cancer. It is now being studied for use in earlier-stage cancers, and for more kinds of malignancies, studies that - if successful - could have many more people using it for far longer.

Which brings the question into even sharper relief: Is Avastin worth it?

This is more than a simple ethical exercise. Health insurance companies do this kind of calculus all the time - deciding whether a therapy or drug works well enough to warrant the costs to policyholders and shareholders. Medicare costs are surging ahead, in part because it's hard to say no to therapies that will extend life, no matter how briefly. Almost a third of Medicare spending goes to patients in the last year of life.

All that amounts to untold billions of dollars spent to add a month or two out of a life that will end soon regardless. If it seems heartless to put a value on another visit with the grandchildren, another sunset, another walk on the beach, a broken health care system has left us with no choice.

Unless the nation wants to bankrupt itself, or wants insurance companies making this decision, it needs to have a long overdue conversation on what life is worth, even when it is measured in a matter of months.