First episode: Family #1 consists of a mom a dad and their 16 year old daughter. The daughter suffers from a newly discovered chronic condition that doesn't affect her life expectancy but greatly decreases her quality of life. She is in constant pain and can only go to school or work for 3 hours a day, and she spends most of the day in bed. Her pain is treated with various pain killers and she takes sleep medication every night. There is a very expensive life-long treatment available for her, which would not cure her, but alleviate the pain and give her an opportunity to lead an almost normal life. Family #2 consists of three young children, a stay-at-home mom and a dad who manages a car-dealership. The dad was recently diagnosed with a condition for which the available treatment is not very effective. He will probably only live another 5-10 years, and in those years he will gradually become more and more sick and eventually bedridden. The viewers of the reality TV show are presented with both cases, the treatment recommendations from various doctors and friends and relatives of the families. The families are then given a 3-minute opportunity to plea with the viewers to chose their family for covered medical treatment over the other.

This scenario is thankfully still pure imagination. But after getting a small peak in behind the healthcare decision-making curtain last week, I can't help but wonder if there is more truth to this image, than I would like to think...
Last week I attended a workshop discussing personalized medicine and health economics in British Columbia (BC). The participants were a mix of researchers, policy makers and industry, and the four speakers each gave their perspective on how BC will tackle the ever increasing cost of healthcare and the need for new treatments, including personalized medicine.

While listening to the four speakers at the workshop and their very valid arguments for why we can't afford to treat everyone, a strange and very uncomfortable feeling snuck up on me. Images of reality TV shows, where the viewers get to chose between two patients, deciding who gets treatment and who doesn't, started flashing in front of my eyes (somewhat due to the catastrophic lack of coffee at the conference, making way for lots of half-awake/half-asleep pictures and ideas in the late afternoon). One of the speakers presented a beautiful graph showing the cost and "value" of a certain treatment combined with the available healthcare budget in BC. The graph displayed how any given treatment needs to live up to a certain threshold of Value/Cost ratio, to be considered for coverage in the BC healthcare plan. If it lives up to that Value/Cost ratio, it is moved to the side of the graph that is within the budget, but it will inevitably push out other treatments that we no longer have money for. Logical but unpleasant! In this day and age there are so many treatments available for so many conditions that we have the luxury - or curse, if you will - of choosing who gets to be treated and who doesn't. 
Picture
The graph on the left shows how the Value/Cost ratio for treatment 1-7 is deemed high enough to qualify for healthcare coverage. While treatment 8-10 does not qualify. The red bar represents a new treatment considered for qualification. The graph on the right shows how the new treatment (red bar) had a Value/Cost ratio that just qualified for healthcare coverage. But in the process it pushed out treatment 7, which is now no loner covered. These graphs are my own remakes of the one shown at the workshop.
This discussion of Value/Cost ratios obviously led to the question of how "value" is determined. Is it how many years it adds to the average life expectancy, or is it determined by increasing quality of life, productivity (value for society) or something else? And that is obviously down to a judgement call from the Canadian Agency for Drugs and Technologies in Health (CADTH) and the decision makers in BC. The speaker was jokingly saying that "any treatment will usually add to either the quality of your life or the length of your life, or both. And if it does neither it is probably chemo." He is probably right, but how do you decide on behalf of someone else if quality or length is more important?
Several of the speakers pointed out that Canadians define themselves by their healthcare system. They are very proud of the general idea that healthcare is for everyone and everyone is covered. But will that continue to be the case, as the cost of healthcare increases and the number of treatments keep going up? Is a reality show like the one I described in the beginning of this post as outrageous as it initially seemed?
 


Comments

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Anne
02/14/2014 11:55am

Thanks you. I do my best.

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02/14/2014 11:52am

It is so weird that she can only go to school or work for 3 hours a day only :/ :(

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Anne
02/14/2014 11:57am

It is a fictional case, but there are many conditions - mental and physical - that limit people to work for only a few hours a day.

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02/24/2014 10:45am

@Anne: I think you are right..

02/18/2014 6:19am

This scenario is thankfully still pure imagination. But after getting a small peak in behind the healthcare decision-making curtain last week, I can't help but wonder if there is more truth to this image, than I would like to think...

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03/28/2014 9:56am

Thank you for your nice comments. I have been a bit busy with other things lately, but I hope to post more soon.

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06/01/2014 1:35pm

One of the speakers presented a beautiful graph showing the cost and "value" of a certain treatment combined with the available healthcare budget in BC.

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    Author

    I am a biochemist, currently working for a start-up biotech company in Vancouver. After hours I write and edit science stories for a variety of magazines, newsletters and health authorities throughout Canada. In this blog I mainly write about the challenges and debates that permeate the research community within academia and in industry.
    As coordinator for the ScienceOnlineVancouver meetings, active member of the Canadian Science Writers' Association, and participant in the Banff Centre Science Communications program 2013, I am also deeply involved in the Canadian science communications community, and often blog about matters of #scicomm. 
    Opinions are my own.

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