Medical societies consider cost as part of treatment recommendations

The outsized cost of healthcare delivery in the U.S. may finally affect individual providers' treatment decisions.

Some medical trade groups, such as the American Society of Clinical Oncology, the American Heart Association, and the American College of Cardiology are compiling guidelines that blend treatment recommendations with cost considerations, the New York Times reported.

The U.S. is under pressure to rein in costs, particularly since it spends $2.7 trillion on healthcare every year, and the country's outcomes are often unfavorable compared to nations that spend far less. Patients also now demand that the system provides greater price transparency.

The care delivery cost differences between the U.S. and other countries are stark. For example, Nexium, which is used to treat acid reflux, costs more than nine times as much in the U.S. as it does in the Netherlands, according to the Huffington Post. A day in the hospital costs about three times as much in the U.S. as it does in Australia, which has a similar standard of living.

However, there are ethical concerns raised about physicians considering costs in their care decisions, according to the Times.

"There should be forces in society who should be concerned about the budget, about how many MRIs we do, but they shouldn't be functioning simultaneously as doctors," Martin A. Samuels, M.D., the chairman of the neurology department at Brigham and Women's Hospital in Boston, told the Times. "I'm not going to do what I think is best for you because I think it's bad for the healthcare budget in Massachusetts."

There are also regulatory concerns. Lucentis, approved by the Food and Drug Administration to treat macular degeneration, costs about $2,000 per dose. The FDA has not approved Avastin, which costs only about $50 a dose and is about as effective as Lucentis, for use in the eyes, according to the Times, although physicians have the option of doing so under under the "off-label" option.

There are also potential conflicts of interest in having medical societies--which represent the interests of certain physicians--make cost-versus-care decisions. Partly as a result, the American College of Cardiology will rely on economic models developed in Europe to make recommendations rather than conducting its own research, according to the Times.

To learn more:
- read the New York Times article
- here's the Huffington Post article
- check out the International Federation of Health Plans study (.pdf)

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