In a message dated 6/22/00 9:38:18 AM Pacific Daylight Time,
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> We all have self-interest to some
> extent, and faced with a disorder or positive test (as pointed out nicely
in
> the mammogram, example), we are more likely to choose things of marginal
> benefit.
As an American, I have found the discussion of NICE and betaseron
fascinating. My hopefully useful addition to the discussion takes off from
Dr Sontheimer's comment.
What he says is undoubtedly true. But, the question is who should pay the
bill for that thing of marginal benefit? I suggest that for things of very
marginal benefit, the individual should be the one who must figure out if
they are willing to pay. And, as has been expressed very well, probability
enters into the discussion.
"Mrs. Jones, you have a "x" in "y" probability of improving with
betaseron. And it will cost you about $10,000 (U.S.--I believe that this is
the approximate cost in US dollars). All patients will choose a treatment
whose chance of benefit is marginal if they bear no cost. The ratio of
benefit to cost for them is then all benefit. Only if the individual bears
the cost (or at least part of it) will they have a similar perspective as
NICE, for example.
Cheers and Best Wishes,
Brian
....................................
Brian Budenholzer, MD
Director, Clinical Enhancement & Development
AC18
Group Health Cooperative; Network Services Division
PO Box 204
Spokane, WA 99210-0204
USA
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509/ 838-9100 X 7393
fax: 509/ 458-0368
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