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Health Effects Of Comparing Care: No Easy Answers

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Health Effects Of Comparing Care: No Easy Answers

Health Effects Of Comparing Care: No Easy Answers

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STEVE INSKEEP, host:

One problem that brought down GM was the rising cost of health care. President Obama says he wants to restrain health costs for all Americans. And this next report explains why that will be so hard. The administration says it wants to steer doctors and patients toward the best treatment, not just the most expensive. They argue that the most costly treatment often is not needed.

There may well be several approaches to a medical problem, each with a different price tag. The trouble is that frequently, nobody - not even your doctor - knows which treatment works best. Consider this example laid out by NPR's Joanne Silberner.

JOANNE SILBERNER: A few months ago, Jay Allen was in one of those situations where he had to do something. Allen began having breathing issues on his 14-mile bike commute. From a bench outside the Washington, D.C., office where he does security work for the federal government, he recalls how it all started.

Mr. JAY ALLEN (Security Officer): It was during these bikes that I would occasionally - actually, during the biking, have an onset of just what seemed to be shortness of breath. And then occasionally, I'd get the same shortness of breath just sitting at my desk or waking up in the middle of the night.

SILBERNER: At the age of 44, Allen had developed a condition called atrial fibrillation, or a-fib; 2.2 million Americans have it. It's where the top part of the heart occasionally shivers instead of beats, causing shortness of breath, fatigue and palpitations. It can, in some cases, lead to heart failure or stroke. Allen recites the options he got from his cardiologist.

Mr. ALLEN: Just wait in general and deal with the conditions. Then there's the options for the various drugs that are out there on the market to help control the a-fib.

SILBERNER: The drugs have potentially serious side effects, like uncontrolled bleeding, and aren't always effective. There are also two dramatic options, a quick shock to the heart delivered through the chest wall. The abnormal heart rhythms, though, eventually reoccur in about half of patients. And there's a new surgical procedure where a shock is delivered through a catheter threaded to the heart. It's been proven to work for up to a year. Out beyond that, its effectiveness is unknown, according to a new government review.

The cost for daily medication is generally dollars a day, for life. The heart shock technique is about $1,000 or $2,000 in Washington. The surgical procedure is tens of thousands of dollars. Doctors may be able to tell you what it's going to cost you, but they don't have the data to tell you which approach will let you live the longest, says cardiologist Stuart Seides, a partner to the doctor who took care of Jay Allen.

Dr. STUART SEIDES (Cardiologist): You really can't. Certainly, there is no data at present to be able to say to a person that one or another treatment is superior in terms of the kind of hard endpoints that you're talking about.

SILBERNER: Right now, he and his patients work out treatment decisions based on whether the patients are more comfortable with drugs or surgery. Seides would love comparative survival information, but…

Dr. SEIDES: I also feel that one of the things we don't want to do is stifle innovation by creating large studies, getting some outcomes and saying, okay, this is the way that we treat atrial fibrillation, you know, and this is the way that we treat this, and this is the way that we treat that.

SILBERNER: Carolyn Clancy knows that. She's head of the government agency that just did the analysis that found that not enough is known about a-fib treatment.

Dr. CAROLYN CLANCY (Director of Health Care Research Agency): What doctors like is tools, not rules. Our intent is not for the information to be prescriptive, but to be descriptive.

SILBERNER: Her agency does not compare the economic costs of each treatment, just the medical risks and benefits. She says the government has to do it because the studies won't get done if left up to the drug and medical device makers.

Dr. CLANCY: It's not in their interest to be able to say well, gee, how well does my new treatments compare to others?

SILBERNER: Some of them, quite expensive, aren't necessarily the best choices. Her agency is getting $300 million of the $1.1 billion stimulus money for comparative effectiveness research. As for Jay Allen, he opted for the a-fib surgery. He wanted a quick fix, and he says even if the survival odds turn out to be less than for the other approaches, he'd choose the surgery anyway.

Joanne Silberner, NPR News, Washington.

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