April 17, 2014 – As prescription drug costs continue to rise, doctors are rewriting their clinical guidelines. Does taking cost into consideration necessarily lead to rationing?
Andrew Pollack, writing in The New York Times, identifies a controversial shift in thinking as doctors begin to weigh the cost of their treatment decisions not just in outcomes, but in dollars. This follows a announcement by the American College of Cardiology and the American Heart Association that they will begin to use cost data to rate the value of treatments in their joint clinical guidelines.
“In practical terms,” Mr. Pollack writes, “New guidelines being developed by the medical groups could result in doctors choosing one drug over another for cost reasons or even deciding that a particular treatment is too expensive.” Indeed, according to the author, “Some critics have said that making treatment decisions based on cost is a form of rationing.”
A 2013 review revealed that 17 of 30 of the largest pysician specialty societies explicitly address cost as part of their clinical guidelines. The cardiology societies, meanwhile, plan to rely on published litereature to rate the value of treatments based on the cost per quality-adjusted life-year, a method used in Britain and by many health economists.
Dr. Paul A. Heidenreich, co-chairman of the committee that wrote the new policy said, “We couldn’t go on just ignoring costs.” According to Mr. Pollack, “The cardiology societies say that the idea that doctors should ignore costs is unrealistic because they already have to consider the financial burden placed on the patient. ‘Protecting patients from financial ruin is fundamental to the precept of do no harm.”
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