Spending Does Extend Life
By
Jeff Donn
Associated Press
BOSTON (AP) -- Despite exploding
costs, most Americans got sizable life-extending
bang for their medical bucks over recent decades,
says one of the most sweeping studies ever of
health-care value.
That might come as a surprise to anyone who has
ever shuddered over a medical bill, and the report
itself raises doubts over how quickly costs have
escalated.
However, the study calculated that Americans of
all ages spent an average of $19,900 on medical
care for each extra year of life expectancy gained
over the last four decades of the 20th century.
And that cost is worth it, the study authors say.
"On average, the return is very high,'' concludes
study leader David Cutler, a Harvard University
health economist. "But it's getting worse
for ... in particular, the elderly.''
The federally funded study by researchers at Harvard
and the University of Michigan was being published
Thursday in the New England Journal of Medicine.
The researchers measured value by the cost of
care that extends the average person's life by
one year. The $19,900 spent for each extra year
of life -- when averaged over 40 years -- would
be widely considered a reasonable value. Many
public and private insurers routinely pay for
treatments that cost up to roughly $100,000 for
each additional year of life.
The researchers attribute this this relatively
low cost for longer lifespan to things like cheap
blood-pressure drugs that prevent heart attacks.
However, the study also outlines disquieting trends.
It finds that inflation-adjusted costs from birth
rose fivefold between the 1970s and 1990s, when
the cost of an additional year of life span peaked
at $36,300. That means each health care dollar
of the 1990s, when expensive drugs made modest
impact on cancer, bought a fifth as much real
value as 20 years before, when cheaper medicines
saved many lives.
Values deteriorated seriously for older people,
the study finds. By the 1990s, 65-year-olds paid
$145,000 for each additional year of life gained
-- a value that would be challenged for many individual
treatments. These higher costs presumably come
largely from end-of-life care that doesn't extend
life very much.
Health policy chief Kathleen Stoll, of the advocacy
group Families USA, said she believes the study
suggests real value anyway. "Each increment
of gain is more expensive now, but certainly very
valuable to the person involved and their family,''
she said.
Others were troubled. "The fact that someone
is writing this paper shows how desperate the
health care system is to justify these out-of-control
increases in health spending,'' said consumer
advocate Dr. Sidney Wolfe, who heads health research
at Public Citizen.
The researchers admit their calculations give
only a partial picture of value. They started
by calculating average changes in both medical
spending and life expectancy for various age groups
in each decade. Then they divided changes in spending
by changes in life expectancy, yielding the cost
per year of life gained.
But many factors extend life apart from medical
care, like not smoking or keeping extra weight
off. So the researchers turned to previous studies
suggesting that about half of all gains in lifetime
stem from medical care -- and adjusted their findings
accordingly.
Even the researchers acknowledge this adjustment
could be off. Others familiar with their findings
said their calculations -- while potentially useful
for the big picture -- had to overlook other important
factors, like the impact of care on quality of
life and the amount of waste in the medical system.
"It really doesn't tell you whether we are
spending too much on what doesn't matter and too
little on what does,'' said Dr. Harlan Krumholz,
a cost-effectiveness expert at Yale University.
Others worried about future costs, though the
study makes no projections. "The growth in
medical spending is unsustainable over time --
both in terms of absolute dollars and the benefit
it yields,'' said health care analyst Steven Findlay