A thought about research on medical economics

Source: "Health-care economics: Comparison shopping," The Economist, January 10th 2008.

I quote:

MOST industries have grasped the idea that new products should be measured against rival offerings. From laptops to double-glazed windows, consumers have ready access to comparative studies from consumer magazines, independent testing bodies and the like.

When it comes to health care, however, comparative-effectiveness studies for new drugs, devices and procedures are rare. Drugs trials often compare new treatments with placebos, not rival pills. Device makers rush to get new gizmos into action before cost-benefit analyses can be done. In America the federal government's health programmes eschew comparative-effectiveness tests as a matter of policy.

Comment: The article goes on to note a few examples of cost-effectiveness studies in health care that have proven useful. Of course, the editorial viewpoint of The Economist supports this kind of work, as I do in principle.

There are, however, ethical problems with comparing the cost effectiveness of alternative medical treatments. How does one deny what is felt to be the best treatment to some patients to evaluate whether there is in fact a difference as compared to the alternative?

In the real world, in developing countries, physicians are often faced with providing advice to patients that identifies various courses of treatment, each with its own cost implications and prognosis. Patients who can not afford the most efficacious treatment often must settle for the best treatment that they can afford.

This situation presents a natural experiment, and it might be very helpful to create a strong medical record system that records diagnoses, treatments and outcomes in such a way that the cost of treatments could be inferred. Data mining might then allow physicians to provide better information to their patients as to the costs and efficacies of alternative treatments for their medical problems.

Indeed, developed nation's support for the such programs where they would be ethical might help the world to avoid more costly but no more efficacious medical interventions. JAD