The health economic blues

Some days my heart sinks and I feel like screaming. Sometimes it is related to explaining health economics. And often it is to one of my colleagues and occasionally a consultant. The last one was a real head:desk experience. I actually thought that the concept was simple, but either I am lousy at explaining things or…… perhaps people just don’t want to listen!

So here we go…. I was talking about a product used in patients with advanced CKD, but pre-dialysis. I guess that I might have been put of my guard a little be the opening gambit:

“It’s more expensive!”

Well yes that is true, but the treatment is cost dominant over 3 to 5 years. Adding a little explanation – ‘it generates better clinical outcomes and the overall costs are less’. That is usually accepted as a reasonable explanation of cost-dominance.

“And what happens after 5 years then?”

Certainly at 10 years it ceases to be cost dominant, but can still be described as cost effective.

“Ha – so it will cost us more after 5 years.”

Yes, that is true. You see significantly more people are still alive at 5 years and they are still taking the medicine and using services. That is often the problem with health economics – dead people are usually less expensive.

“I don’t know whether we can afford to use more of it”

But as you can see over the first 3 to 5 years it will actually cost you less money. And we should be happy that significantly more people are still alive after 5 years.

Well, I now am looking into a ‘sorry face’ and my head has hit the desk. I just don’t know what to say. My NHS, will continue to use the treatment that appears to be cheaper, but will cause more hospitalisations, more will start dialysis and more will die and over 3 years will cost more money. Is it because they don’t understand basic health economics? Is it silo budget mentality?

And, as a parting shot, who is it that says ‘we can’t afford to spend less money and keep more people alive’ – it certainly isn’t me – and it won’t be the patients!


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