Navigating Ethical Practices in the Era of High Cost Hematology
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HEALTH ECONOMICS (N KHERA, SECTION EDITOR)
Navigating Ethical Practices in the Era of High Cost Hematology Natalie Ertz-Archambault 1 & Nandita Khera 1 Accepted: 17 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review In this review article, we will highlight ethical issues faced by hematologists due to a growing constellation of expensive diagnostics and therapeutics in hematology. We outline the important issues surrounding this topic including stakeholders, cost considerations, and various ethical challenges surrounding access to care, communication about costs, and individual vs. societal responsibilities. We review available tools to navigate these ethical themes and offer potential solutions. Recent Findings We identified several gaps in the literature on the topic of ethical issues in hematology treatment and supplement by non-hematological cancer and general medical literature. Summary We propose proactive solutions to address these problems to include cost transparency, utilization of evidence-based decision making tools, application of the four quadrant approach to ethical care, and advanced systems-based practice curriculum for physician trainees. Keywords Biomedical ethics . Hematology . Healthcare cost . Decision making . Ethical analysis
Introduction Dr. A, a hematologist at a nonprofit cancer hospital in Texas, would like to treat a 69-year-old female patient from a small town in New Mexico with relapsed diffuse large cell lymphoma with axicabtagene ciloleucel (priced at $373,000 for the product plus costs associated with care and management of complications). Dr. A is worried about the ability of the patient to meet the out of pocket expenses from the treatment as well as those due to the need for relocation close to the cancer center. He is also the chair of the committee at his cancer center that is evaluating the ability of the center to offer these treatments to the patients. The leadership at the cancer center is concerned about the huge gap between the actual cost and reimbursement from Centers for Medicare and Medicaid Services (CMS) for these treatments affecting the sustainability of being able to provide such treatments to a large number of patients needing it [1–3].
This article is part of the Topical Collection on Health Economics * Natalie Ertz-Archambault [email protected] 1
Division of Hematology and Medical Oncology, Mayo Clinic, 5777 East Mayo Blvd., Phoenix, AZ 85054, USA
The case very well illustrates the ethical dilemmas faced by the hematologists in this era of exploding innovative scientific advances with a high price tag. The practice of medicine today highlights the conflict of being an advocate for the best interests of one’s own patients while balancing stewardship of finite societal resources. The absolute prices of therapies in hematology and oncology are highest in the USA compared to other countries and account for the largest spending of any specialty globally [2, 4–8]. Price tags in the range of a hu
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