Insurance companies are starting to see the light. According to the Wall Street Journal insurance companies are eliminating payment for proton beam therapy for prostate cancer because less expensive and effective treatment already exists. This is a good example of the reasonable application of cost-effectiveness evaluation. Finally.
Standard radiation therapy passes through the body damaging all tissue in its path. The point is to damage the prostate with cancer in that same beam path. Injury to tissue in front and in back of the prostate is reduced by rotating the beam around but still keeping focus on the prostate.
Proton beam radiation damages tissue to a specific depth — the beam does not damage tissue beyond that depth. In essence, lessening the damage along the exit track compared to standard radiation.
The concept of proton beam therapy is great, except for building a giant machine to make the beam, except for the huge expense of the machine and not much gain in the death rate from prostate cancer compared to standard therapy. How can this be, high tech is supposed to be better?
The problem is: proton beam therapy is just a little better than standard therapy but it is hugely more expensive. Proton beam therapy costs $32,000 versus $19,000 for standard therapy.
Researches often calculate how much a therapy costs to extend quality life by one year (one QALY or quality adjusted life year). This type of analysis was done by researchers in Philadelphia. They found the cost per QALY for a 70 year old man for proton therapy is $63,511 and for standard therapy is $38,808.
As stated in previous posts most health care experts believe the cost per QALY should not exceed $50,000. Basically, the limitation is based on how much money can be spent without bankrupting society. Another way to look at the cost is that the treatment is not ready yet — research must find ways to make it workable at a lower cost.
The bottom line is insurance companies are making decisions on these really high priced treatments like other countries do, by considering costs and benefits. Unfortunately, this decision process is not widespread. Unless this type of analysis happens on a larger scale there is little hope for US health care solvency.
Insurance companies are usually not big enough to withstand the complaints and suits from that one person demanding the higher priced care. Eventually, the US government must insist on this type of cost control.