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.