Your Money or Your Life

Imagine you are given a choice: you can live for one more year by paying cash or you can cash out now (aka go into the fertilizer biz, become living challenged, kick the oxygen habit).  How much money would you be willing to pay?

Unless you are frenemies with the Godfather, this is a hypothetical question, but the mafia_donanswer to it helps scientists estimate how much a medical intervention is worth.  It is called a “Quality Adjusted Life Year” or “QALY” (sounds like koala but with “eee” instead of “ah” at the end).  This question is posed by researchers to real people around the world, and the responses are aggregated to come up with the value of one year of life.

Everyone has some level of willingness to pay or “WTP” for a year of life.  The Quality Adjusted part takes into account how well the person is for that year.

QALYs are compared to the actual cost for a medical treatment, and costs of other social factors plus the time value of money, and the local citizens’ WTP.  For example, per one quality-adjusted life year gained,

  • Vaccinating boys for HPV (human papilloma virus which causes cervical cancer in females) costs $61,400.
  • Vaccinating girls for HPV costs $17,400.
  • School-based eating disorder screening costs $56,500.
  • Some medication regimens for schizophrenia cost $542,000.

In theory, we could choose to put more money into things that gave us more years of life per dollar spent.  We could choose to subsidize the girls’ HPV shots but offer it to the boys at full price, for example.

If only we could be so Walmart shopper-like in this, we might have a very different health world.  But the reality is that we, especially us Americans, cannot do that.  On the contrary, we spend outsize amounts on things that do not improve or extend our lives.  Examples are controversial – such as high cost cancer drugs that give a person a few more weeks or months.

I think we spend the money because we get something else from it – hope.  It is too much to ask a human society to be rational about life itself and make choices that ultimately visit upon its members.  When a person argues against a new expensive treatment, he is accused of being cold-blooded and what would he do if his own grandmother needed it, and so forth.

It is essentially too late for any arguments once a treatment or technology has been invented.  Somehow, we need to steer innovation toward things that deliver more years of life for more people.  This is not what happens today.  If saving lives were our priority, surely we would have cured malaria by now.  Half the world’s population is at risk for malaria, and around 600,000 people die from it each year, mostly children under age five.  That’s a lot of life years wasted.  Perhaps the reason malaria continues to kill – though at much lower rates than 10 years ago – is that 90% of malaria deaths are in very poor African countries.  Poverty is not a magnet for innovation.

Instead, innovation gravitates to where profit can be made.  Yet even life-saving or extending has a limit – life does end at some point, no matter how much cash or treatment a person has.

In the end, we pay dearly for a flash of hope and that may be the best we can do.

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