What is cost-effectiveness in healthcare?
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I decided to start this thread in view of recent events in the UK and an exchange of letters between MOH and Mui Hoong, the Straits Times columnist.
There are now many new anti-cancer drugs that are much more effective than the ones previously available. At the same time, there are better and more accurate diagnostic tests that can predict responsiveness to such newer treatments. However, all of these are expensive and are not available to most Singaporeans.
The government does not want to put these drugs into the standard drug list because they are expensive. So patients in the West with mammary gland cancer, for example, have a better chance of a cure because they have access to these newer drugs. On the other hand, Minister of Health has said that he wants to moderate, not increase, the expectations of Singaporeans where healthcare is concerned.
The journalist Chua Mui Hoong is fortunate in that she was given the drug Herceptin when she developed breast cancer as a postgraduate student in Harvard. Our patients do not have access to this drug and it is unlikely to be subsidized by the government.
As pointed out by another journalist, Herceptin increases the chance of a cure for early breast cancer from 60% to 80%. That means 20% pf patients will die from the cancer even with the drug and 60% will be cured anyway, with or without this new drug. There are lots of women with early breast cancer now that we are doing breast screening to pick them up early; and it will cost a lot to subsidize Herceptin treatment for all of them.
There are many new anti-cancer drugs like Herceptin, some are more effective and with less side effects. But they are all expensive and with our budding biomedical industry in Singapore, there is no way we can follow the Thais and Indians who use local legislation to make generics, ignoring their patents.
Is it cost effective to pay thousands of dollars just to improve the cure rate by 20%, even though it is clearly statistically significant? The question is, what if you fall in that 20%?
Another question that often confronts us: Is it cost-effective to pay thousands of dollars to increase the lifespan of a cancer patient by 15 months? What about 12 months? 5 months? 3 months?
What about a drug that does not improve overall survival time but gives you a better quality of life during that period? Is it cost-effective to give such a drug?
There are times when I feel disillusioned. My work has contributed in a small way to improving diagnosis and treatment of cancer; but only the rich can benefit from it.
If there is interest, perhaps I can use this thread to talk about some of these newer drugs...
(Just realized that the common word for mammary gland is banned or something...each time I type'breas_' it turns out gabbage...wonder why?) -
Basically, Singapore is not like other countries, who is willing subsidize a lot. Singapore's economy is not as strong as the countries even though we are quite developed when compared with other Asian countries. Our economy cannot support these huge subsidies. If we want, our people have to pay more taxes and higher taxes. This will cause a lot of Singaporeans to migrate and therefore losing our first and only resource - humans.
If we lose this only resource, we will get poorer, and maybe we will no longer able to subsidize all the medication we are taking now.
Another thing is that Singapore doesn't like to give free gifts. This will result in misuse. One very good example is Britain. Because their healthcare is free, they misuse it. We don't want this as this will cripple our economy.
Although I understood what you mean, these drugs can be further improved and therefore could be cheaper. As technology evolves very fast, these drugs will be cheaper in a few years' time and the government will consider to subsidize it. -
The reason why these drugs are expensive has nothing to do with technology. Many of them are very cheap to produce. The problem is that pharmaceutical companies have patented them for at least 10 years and so nobody can make these drugs during this period and we will have to pay a high prie for them.Originally posted by ndmmxiaomayi:Basically, Singapore is not like other countries, who is willing subsidize a lot. Singapore's economy is not as strong as the countries even though we are quite developed when compared with other Asian countries. Our economy cannot support these huge subsidies. If we want, our people have to pay more taxes and higher taxes. This will cause a lot of Singaporeans to migrate and therefore losing our first and only resource - humans.
If we lose this only resource, we will get poorer, and maybe we will no longer able to subsidize all the medication we are taking now.
Another thing is that Singapore doesn't like to give free gifts. This will result in misuse. One very good example is Britain. Because their healthcare is free, they misuse it. We don't want this as this will cripple our economy.
Although I understood what you mean, these drugs can be further improved and therefore could be cheaper. As technology evolves very fast, these drugs will be cheaper in a few years' time and the government will consider to subsidize it. -
I support the use of generic drugs, or government actions that enable cheap generic drugs on the market. I read all governments have this power to 'infringe' pharmeceutical companies rights and patents on their medicines but the problem is not many government agencies are willing to incur the wrath of these industry giants, lets say Roche, Bayer, etc.
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it is always the same thing isnt it?
you have money, you have the best.
you have no money, i put you to rest. -
We have to wait at least 10 years so that people can pay a lower price for it? If saving lives are so important, why do they want to make it so expensive? Pricing them lower will not hurt their profits anyway. Probably part of the money goes into R&D, to make the drugs better and reduce the side effects.Originally posted by oxford mushroom:The reason why these drugs are expensive has nothing to do with technology. Many of them are very cheap to produce. The problem is that pharmaceutical companies have patented them for at least 10 years and so nobody can make these drugs during this period and we will have to pay a high prie for them. -
Sorry...my mistake. The patent period is 20 years, not 10!Originally posted by ndmmxiaomayi:We have to wait at least 10 years so that people can pay a lower price for it? If saving lives are so important, why do they want to make it so expensive? Pricing them lower will not hurt their profits anyway. Probably part of the money goes into R&D, to make the drugs better and reduce the side effects.
So you will only get to buy at close to cost price drugs that are 20 years old. If Singaporeans are willing to accept that, then it's not a problem.
You are right that pricing them lower will not hurt their profits but you are wrong to suppose that they are in the market to save lives. The pharmaceutical industry is the most profitable...why do you think Singapore is getting into this game.
They often quote the cost of R&D, which is only partly true. The fact is that they earn huge sums of money...in fact, of my investment portfolio, I must admit that the best performers have been those in the biotech industry. -
20 years a bit too long. By then, newer drugs would have been out. 10 years can accept. R&D not easy, so I give 10 years' grace.Originally posted by oxford mushroom:Sorry...my mistake. The patent period is 20 years, not 10!
So you will only get to buy at close to cost price drugs that are 20 years old. If Singaporeans are willing to accept that, then it's not a problem.
You are right that pricing them lower will not hurt their profits but you are wrong to suppose that they are in the market to save lives. The pharmaceutical industry is the most profitable...why do you think Singapore is getting into this game.
They often quote the cost of R&D, which is only partly true. The fact is that they earn huge sums of money...in fact, of my investment portfolio, I must admit that the best performers have been those in the biotech industry.
If they are not in the market to save lives, why are they into it? Just because they are profitable? -
such is the shallow vision of our elite. drop by drop an ocean is form. giving the patients durgs which is less effective may means that they will need more consumption or longer time to recover. and time is money. more consumption will also means more monies. Worse will the the ineffectiveness of the durgs and the loss of life.
and to always remind you that health care is "subsides" by providing ineffective diagnosis and medication is unacceptable.
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Why are our ministers working as ministers? Because they want to serve Singapore?Originally posted by ndmmxiaomayi:If they are not in the market to save lives, why are they into it? Just because they are profitable?
But this is not the intention of this thread....the question is, will you pay $3000 a month for your parent who has cancer and needs a drug that will prolong his life by 6 months? Do you think it is worth it? -
In rupiah will pay. Sing dollars no. And like you said, it is cheap to produce the drugs. I will rather open a pharmaceutical company and make the drug myself and give my parent the drug.Originally posted by oxford mushroom:Why are our ministers working as ministers? Because they want to serve Singapore?
But this is not the intention of this thread....the question is, will you pay $3000 a month for your parent who has cancer and needs a drug that will prolong his life by 6 months? Do you think it is worth it? -
They will sue you for violating their patent..Originally posted by ndmmxiaomayi:In rupiah will pay. Sing dollars no. And like you said, it is cheap to produce the drugs. I will rather open a pharmaceutical company and make the drug myself and give my parent the drug.
How about smuggling generic medicine to sell to the poor? There's no death sentence and even if you are caught, most people will consider you a robin hood.
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LOL, sue me for violating their patent. Then steal drugs to give my parents best. Free, no violation of patent, no death sentence. If got extra drugs, still can give others, people will see me as Robin Hood also.Originally posted by oxford mushroom:They will sue you for violating their patent..
How about smuggling generic medicine to sell to the poor? There's no death sentence and even if you are caught, most people will consider you a robin hood. -
Originally posted by ndmmxiaomayi:LOL, sue me for violating their patent. Then steal drugs to give my parents best. Free, no violation of patent, no death sentence. If got extra drugs, still can give others, people will see me as Robin Hood also.
unless you have partners like Little John, I doubt you are going that far... 
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Let me quote their maxim: it is profitable to save livesOriginally posted by ndmmxiaomayi:If they are not in the market to save lives, why are they into it? Just because they are profitable? -
Perhaps doctors can at least inform your patients the price differences between the various medicine options available BEFORE prescribing?
I believe patients &/or their immediate families would appreciate making informed decisions. In general, they should be the one making the economical decision while the doctors make the medical recommendations/decisions?
FYI, I am currently suffering from the aftermath of a bad drug allergy (side effects) as I, unwittingly like most other patients, did not question my Senior Consultant/Senior Doctor's original prescription. However, I am glad that I reported the allergy soon enough. After some discussion of the pros & cons of the options available, my condition has finally shown improvement with the new prescription.
In any case, I appreciate all the efforts by the sincere and dedicated medical personnel out there and in here (this forum). Your valuable advice has been very useful and enlightening.
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Sometimes that is easier said than done. It is difficult to tell a cancer patient and his family that there is a treatment that can remove the cancer and give him possibly a few extra years of life but that the treatment will cost him more than $10,000. The patient and his family will naturally demand the medication even if they cannot afford it and it puts the medical doctor in a very difficult position.Originally posted by zodi:Perhaps doctors can at least inform your patients the price differences between the various medicine options available BEFORE prescribing?
I believe patients &/or their immediate families would appreciate making informed decisions. In general, they should be the one making the economical decision while the doctors make the medical recommendations/decisions?
That is why often the doctor will look at the patient's financial background before deciding whether or not to tell him of the possibility of a more expensive but better medicine. The government has also been telling doctors not to raise the expectations of our patients.
It is not a situation the doctor wants to find himself. Doctors would rather dispense medical advice rather than function as gatekeepers of health economics or MCs but these responsibilities are thrust upon us whether or not we want them. No doctor wants to have distressed relatives weeping and accusing them of being heartless for not prescribing a potentially life-saving medication that he has told them about in the first place. It is easier to keep quiet if the patient is obviously not able to afford it. -
well even coffins aren't cheap//Originally posted by dragg:it is always the same thing isnt it?
you have money, you have the best.
you have no money, i put you to rest.