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How Much to Prevent a Blood Clot?

April 17, 2011

A study in the New England Journal of Medicine several months ago presented findings on a new medicine to prevent a deep vein thrombosis, which is a blood clot in one of the larger veins of the leg. These clots are usually more of an annoyance than dangerous, though the worst case scenario is that a large clot breaks off, travels to the lungs, gets stuck in a large artery in the lung, and is lethal.

Since the drug is new, almost by definition it is extraordinarily expensive. The authors of the study did not mention the cost, but in the narrow reductionist world of academic medicine, this silence is not a major detraction. The purpose of this study was only to talk about the effectiveness of the new drug. There was no requirement to discuss larger societal issues such as the fact that all insurance plans that approve this drug will become more expensive the moment they start paying for their members to use the drug.

So kudos to the NEJM for taking the unusual step of including an editorial shining the light on the horrible cost-effectiveness of this new drug. Drs. Lee Goldman and Jeffery Ginsberg estimated that any future savings from fewer serious blood clots would be overwhelmed by the initial cost of the drug: somewhere between $2,100 to $7,400 for a 45-day course of daily injections. The trial of the new drug did not find that lives were saved, only the inconvenience of developing a new blood clot that would then require treatment. Using the original study data, Drs. Goldman and Ginsberg estimated it would cost a net $186,000 to reduce one symptomatic blood clot.

We need more prominent physicians publicly questioning the exorbitant cost of American healthcare. We need more major journals to openly question the greater societal harm of using expensive tests and treatments that are marginally effective. It’s way past time for American physicians to propose more cost-effective approaches to healthcare. It’s time for the healthcare system to stop sucking resources away from other industries without even the modicum of a conversation asking if this is what the other industries really want.

As for the NEJM editorial, it represented baby steps, but at least it was a start.

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One Response to How Much to Prevent a Blood Clot?

  1. Christopher Gregory on April 18, 2011 at 9:29 am

    Dr. Young, I applaud (maybe cheer is better) you for being a vocal spotlight on the ridiculous way our system operates. It seems as though we see a never-ending list of new “designer drugs” coming out complete with the television ads designed to frighten consumers about the risks of doing without and/or demanding that their physicians keep them happy by prescribing these drugs. Such is the mindless way our uninformed, ignorant consumers are manipulated into contributing to a system fraught with waste. Direct-to-consumer marketing has been one of the worst offenders of sensible medicine, and the profit-driven drug companies are the architects of these financial outrages.

    By virtue of my proximity to the medical community and the medical economy, I have watched this terribly worsening situation for 30 years, and conclude we have an accomplished cast of accomplices contributing to this accelerating pratfall in our health care system. It is an economic auto wreck that has been occurring in slow motion – that is accelerating. It’s everyone – specialist doctors who control and cling to free-wheeling medicine with no checks on their earning potential, hospitals which are engaged in pursuing the vertical integration of their market shares by trying to monopolize physician communities, drug companies who are fleecing the system with so many spectacular drugs – many of which have suspect efficacy, and consumers who provide the gas in the tank to run this mess by virtue of their ignorance and gullibility.

    So many well-intentioned physicians, notably primary care physicians, are just standing by mutely, keeping their mouths shut both out of the fear of upsetting their already wobbly apple-carts, and out of a sense of futility. If we believe this system is inexorably out of control, then let’s just stand by on the sidelines and wait for the inevitable end of the parade, when the dollars have run out and all of the vested special interests must realize that the new regime spells draconian health care for the masses and the best care for the wealthy elite. Then what? Ask the social scientists what can be expected when the gap reaches a critical point.

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