Oncologists Answer the Question: What is an Added Month of Life Worth?

We recently surveyed U.S. oncologists in order to gain their perspectives on the emerging changes and challenges in the cancer landscape. The survey results spotlight an increasing tension between oncologists’ overwhelming optimism about the state of advancing science and their deep pessimism about the affordability of care.

One particular line of survey questioning addressed oncologists’ views of the value of incremental survival in the context of advanced cancer. We asked a series of questions designed to assess whether oncologists believe a new therapy that improves survival would be “worth it” under a variety of different contextual scenarios. Holding as a constant the assumption that the baseline price of the next best alternative care would total $15,000, we systematically varied: (1) expected survival time with the next best alternative care (either two months or nine months); (2) incremental survival with the new therapy (from one month to 12 months); and (3) the total cost of the new therapy (from $40,000 to $120,000 -- in other words, an increase in $25,000 to $105,000 over the cost of the next best alternative).

There are two key findings from those questions. First, in order for a majority of oncologists to declare the new therapy “worth it” even at the lowest of the prices we tested, the therapy must deliver a median of three additional months of life. Second, for the majority to judge those three additional months of survival an acceptable value, the cost of each additional month must be no more than roughly $9,000 to $10,000, regardless of whether baseline survival is two months or nine months.

Challenging Bioethics of Organ Transplantation: ‘The Book of Jobs’ Raises New Moral Lessons

Gods of Technology Burden Us with Tough Moral Questions

In an uncharacteristic shift from the remote third-person voice of our typical posts, I want to begin by saying that my husband strongly advised me not to write this particular blog. Observing that Steve Jobs was being lionized, almost deified, by the press and public, he warned that no good could come of advancing the view that Steve Jobs’ transplant two and a half years ago, presumably after a Whipple resection, might potentially be a waste of a perfectly good liver.

Which is why, as I type this, I am fingering my adored iPhone (which I actually consider to be a vital organ of my own) like a protective talisman. At least I’m not writing on an iPad.

Even in a society that reveres digital technology, it is rather surprising how delicately, almost timidly, the entire topic has been handled in the press, and how little editorial cross-talk there has been among bio-ethicists, medical professionals, and cultural commentators. There is clearly fear of inviting discussion about the medical or social merits of the case for transplant when the patient is one of society’s most important members as well as one of its most wealthy. In a Medscape commentary from the Cleveland Clinic, John Marshall used the topic as an opportunity to laud our growing ability to differentiate among different kinds of tumors, consigning the transplantation debate to a small parenthesis.