Dear David, Jennie et al.
These interventions may be all well and good, but I think Alan and
Karen's article was principally motivated by the case of very expensive
drugs being funded when they offer very small benefit (if you're lucky)
- Alan: correct me if I'm wrong. This is got relatively little to do
with age, I think. You might get colon cancer when you're, 30, 40, 50,
120...
If you go the pure economic evaluation health maximization route, there
is no way you ought to fund these drugs at current prices, either from a
public payer, or from a private payer (funding such drugs in a private
market increases premiums, decreases coverage etc). I do think there is
more to the pure health maximization route in these cases, something to
do with offering dignity when one reaches the end of life, maybe
something to do with the end of life signifying the quality of a whole
life (I think Aristotle said something along those lines). I haven't
worked it out yet, and maybe never will, but there clearly seems to be
something of profound import that people attach to the end of life.
However, some of these drugs are ridiculous, aren't they? Pharma execs
are buying their second homes in the Napa Valley and god knows where
else and even now are receiving ludicrous bonuses, and the industry as a
whole is constantly pleading poverty. In short, the industry is charging
far too high a price for these products, and we shouldn't lose sight of
that. Their avarice is harmful to society (i.e. to all of us), and thus
there does need to be a focus on whether what we get for these products
is worth what we pay for them.
Very best,
Adam
-----Original Message-----
From: Anglo-American Health Policy Network [mailto:[log in to unmask]]
On Behalf Of David McDaid
Sent: 29 May 2009 23:00
To: [log in to unmask]
Subject: Re: NICE WOBBLES
Yes just to follow up on Jennie's comment - NICE has been looking at the
evidence on interventions to promote mental and physical wellbeing in
older people.
There are some well designed studies indicating not only benefits from
the exercise per se; but also older people (as anyone else) also benefit
from social participation that comes de facto alongside these exercise
activities. Exercise is just one a range of interventions that can help
reduce the risk of serious falls and potential risk of fracture which
can be so debilitating to individuls in both mind and body - and indeed
costly. This is to say nothing of the role that exercise and other
groups activities can have in helping to reduce the risk of serious
depression and suicide in older people.
Again there is a growing evidence base that a range of modest community
based activities can both help with quality of life and as also as it
happens be cost effective. It would be good if health care systems were
to more systematically consider how best to support some of the
community based interventions even when they fall beyond the boundaries
of the conventional health care system.
Best wishes
David
-----Original Message-----
From: Anglo-American Health Policy Network [mailto:[log in to unmask]]
On Behalf Of Popay, Jennie
Sent: 29 May 2009 22:33
To: [log in to unmask]
Subject: Re: NICE WOBBLES
If I could intervene here - hints of ageism here. My 87 year old
working class mother with advanced heart failure goes to ballroom
dancing classes every Friday evening. She doesn't do a great deal of
vigorous activity (!) but that and her weekly French classes
contributing immeasurably (well at least from the perspective of the
non-economists) to her continued high spirits and her ability to remain
active and cared for at home despite considerable ill health -
presumably worth a bob or two to the NHS and/or social care budgets.
Jennie Popay
-----Original Message-----
From: Anglo-American Health Policy Network [mailto:[log in to unmask]]
On Behalf Of Adam Oliver
Sent: 29 May 2009 15:50
To: [log in to unmask]
Subject: Re: NICE WOBBLES
Well, ballroom dancing is increasingly popular.
-----Original Message-----
From: Anglo-American Health Policy Network [mailto:[log in to unmask]]
On Behalf Of Roebuck, Chris
Sent: 29 May 2009 15:37
To: [log in to unmask]
Subject: Re: NICE WOBBLES
E.g., Hip Replacement for 90 year olds.
This is the one I've heard brought up at several conferences.
--------------------------------------------------
M. Christopher Roebuck
Director, Health Economics
CVS Caremark | Strategic Research
11311 McCormick Road, Suite 230
Hunt Valley, Maryland 21031
Phone: 410.785.2136
Fax: 410.785.8140
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-----Original Message-----
From: Anglo-American Health Policy Network [mailto:[log in to unmask]]
On Behalf Of Gemmill, Marin
Sent: Friday, May 29, 2009 9:24 AM
To: [log in to unmask]
Subject: Re: NICE WOBBLES
Alan,
Thanks for forwarding the article - one of your paragraphs brought up a
key point that I'm interesting in hearing other views on. That is,
should we prioritize products that extend the life of or the quality of
life of those with terminal illnesses? And I would go further in asking
how much should third parties be willing to pay for end-of-life care? I
think this debate has major implications not only for the UK but also
for the US where we essentially prioritize end-of-life care for the
insured over covering our 46 million (or so) uninsured.
Marin
Marin Gemmill-Toyama, PhD
Senior Research Analyst, Strategic Research CVS Caremark
Phone: 410-785-3346
Fax: 410-785-8140
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-----Original Message-----
From: Anglo-American Health Policy Network [mailto:[log in to unmask]]
On Behalf Of Maynard, A.
Sent: Friday, May 29, 2009 4:02 AM
To: [log in to unmask]
Subject: NICE WOBBLES
This piece by Maynard and Bloor will appear in the July JRSM.
I hope it is of interest
Best wishes
Alan
-------- Original Message --------
Subject: Proof of article jrsm-10.1258/jrsm.2009.09k031 for
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