The Debate between End-of-Life Medical Choices and Healthcare Costs

Written by Stephanie Hedt, Master of Public Policy candidate 2015, Sol Price School of Public Policy.

Though many popularly cited studies indicate patients making end-of-life choices would rather choose to spend their last days without medical measures that may decrease their quality of life, these simplified scenarios do not adequately acknowledge the reality that medical decisions are sometimes made without full knowledge about what will happen in the future.  That is, patients and their health care providers may not realize that the patient is approaching the end of their life. Without that realization, medical care choices become complicated.

This dichotomy in end of life medical care and the surrounding debate about health care costs is discussed in the recent article “Careful Use of Science to Advance the Debate on the UK Cancer Drugs Fund” published in The Journal of the American Medical Association.  In this article, Schaeffer Center faculty members Darius N. Lakdawalla and Jason N. Doctor along with Anupam B. Jena from Harvard University, evaluate the value that patients place on treatment alternatives.  They assess the choices that patients may make in concert with the renewal of the UK Cancer Drugs Fund, which sets aside money to pay for expensive oncology medications that have not been recommended for coverage. 

Lakdawalla, et al discuss several survey studies that examine the value that patients with a high mortality risk place on treatments that offer uncertain additional survival.  Patients were found to prefer therapies and treatments that offer a hopeful outcome, even if the risks associated with that treatment were greater than the alternative. Furthermore, “[w]hen faced with a scenario in which expected survival is short, most individuals express preferences for treatments that provide a modest chance of a significant survival gain, even if these lower the average survival outcome.” These findings suggest that renewal of the Cancer Drugs Fund may be in-line with societal preferences, even given the acknowledged cost and limited resources.

The full article is available on the JAMA website here.