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A new drug that will soon be requested for approval to the FDA appears to delay serious symptoms and perhaps, extends the lives of women with breast cancer. From the NYT story:

T-DM1 delayed the worsening of disease by about three months. For those who received T-DM1, the median time before the disease progressed was 9.6 months, compared with 6.4 months for those getting the two other drugs. It is still too early to say definitively that T-DM1 also prolonged lives, because not enough time has elapsed since the trial began...About 84.7 percent of patients getting T-DM1 were alive after one year, compared to 77.0 percent of those in the control group. By another commonly used measure called the hazard ratio, T-DM1 reduced the risk of death by 38 percent. The median survival for those getting T-DM1 is not yet known. But Dr. Blackwell said it would likely be at least a year longer than the 23.3-month median survival for the women in the control group.       

This is good news. But the drug will probably be expensive. So I wonder: Would the coming Obamacare cost/benefit boards approve payment for a drug that only delays serious symptoms for a few months, and extends life for (say) about a year?

This is a serious concern. We have seen a prominent article in The Lancet urge that some last ditch life-extending-but-not-saving chemotherapies not be covered by payers. The UK’s NICE has rationed such drugs, ditto in Canada. Oregon’s Medicaid rationing plan, the last I looked, doesn’t pay for chemo for terminal cancer patients if it is not expected to extend life for 5 years. Especially, when increasingly, judgments about these restrictions are based on quality of life and no small amount of health money now goes to fund services as well as treatments.

My guess: Obamacarians would approve this drug, not the least because it is for breast cancer and there is a powerful political constituency behind fighting that particular disease. But I would not be surprised if a less politically impactful disease were turned down for coverage under similar circumstances.  Rationing is intrinsically political.  And it is coming unless we repeal Obamacare.

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