Costs and Benefits: Foreign to U.S. medicine

Last week I introduced my grandmother's struggle to compare the costs and benefits of cancer treatment. Today I wonder how the situation would have been different had she lived in England.

My grandmother's decision to undergo chemotherapy was motivated by a fixation on the rewards of treatment. Family, friends, and even her oncologist shared this focus. We all wanted more time with her, and the doctor told her to expect a return to the golf course. When speaking about her decision, the costs of chemotherapy rarely entered the conversation.

Costs might not have been so thoroughly ignored had my American grandmother lived across the pond. This is because Britons are more familiar with healthcare-related cost-benefit discussions. England's National Institute for Health and Clinical Excellence (NICE) helps spark these conversations by performing cost-benefit analyses on treatment pathways. NICE's decisions often grab headlines and stir debate about effectiveness and spending.

In this environment, my grandmother might have steered away from chemotherapy. She would have had more experience discussing costs and benefits of treatment with family, friends, and healthcare providers, and she would likely have realized that the prognosis for a 92 year-old woman undergoing chemotherapy rarely includes a return to the golf course. Even if she had made the same initial decision to undergo chemo, she might have more quickly abandoned the treatment and avoided some emaciation and exhaustion. Lastly, she might have made the same decision, but she would have at least been more aware of the fact that medicine involves both rewards and risks.

I admire how Brits seem to have a stronger grasp on healthcare cost-benefit analyses and wish that my grandmother had been able to consider chemotherapy with this perspective.

Got a different perspective on British healthcare? Contact Sam: samjmhealth@gmail.com