Declaring the idea of cost effectiveness a “forbidden topic in the health care debate,” Aaron Carroll shows just how adverse we are to the idea of comparing money cost with health outcomes. It’s even written into the Affordable Care Act:
"… we in the United States are so averse to the idea of cost effectiveness that when the Patient Centered Outcomes Research Institute, the body specifically set up to do comparative effectiveness research, was founded, the law explicitly prohibited it from funding any cost-effectiveness research at all. As it says on its website, 'We don’t consider cost effectiveness to be an outcome of direct importance to patients.'"
Tengs, along with Professor John Graham and a team of researchers at the Harvard Center for Risk Analysis, systematically gleaned from the literature annual cost and lifesaving effectiveness information for 185 interventions. Some of these interventions had been fully implemented, some partially implemented and some not implemented all. The researchers then asked: what if we reallocated funds from regulations and procedures that give us a low rate of return to those procedures that give us a high one?
The 185 interventions cost about $21.4 billion per year and saved about 592,000 years of life.
If that same money had been spent on the most cost-effective interventions, however, 1,230,000 years of life could have been saved -- about 638,000 more years of life than under the status quo.
58 yo male at diagnosis: T1bN0M0, 0/15 nodes, low grade/moderately differentiated adenocarcinoma
03/2016 colonoscopy #1: 2 small polyps removed in left colon; CEA = 1.3
04/2016 colonoscopy #2: caecum sessile 3.5 cm polyp piecemeal removed with kind of clear margins
05/2016 "prophylactic" laparoscopic right hemicolectomy - bleeding, leak, infection
06/2017 CT scan, colonoscopy OK; CEA = 1.6
A lot of funny stuff discovered by CT scans in liver, kidney, lungs, arteries, gallbladder and a lymph node