Saturday, March 8, 2014

Allocation of resources: you can't put all bucks in one bucket.

"Selfishness is the greatest curse of the human race." -- William E. Gladstone, four-time prime minister of the U.K. 
With the great increase in the life expectancy in our population, and the advances in medical technology, we are seeing more and more people becoming chronically debilitated, rather than dying from the outset; and with the advances in pharmaceutical industry, we are more able than ever in prolonging life, as well as improving quality of life in patients who would have otherwise died or suffer an ailment that would be worse than dying.

These wonder drugs, however, do not come without a steep price. The question then, is how much is the society willing to pay for these patients? If there is a cap as to how much we're going to pay, would it be based on a "per capita" basis, "per diagnosis" basis, or "per quality-adjusted life-year gained" basis? What is the price of a quality-adjusted life-year?

Taking the most extreme example, given a dose of loratadine (less than $1 hkd/day), and I can be free of my allergic rhinitis symptoms. This facilitates my performance at work, and I guess perhaps I can proudly say that taxpayers funding me the treatment (in the form of a prescription under HA) is probably fair.

On the other hand, a patient with terminal cancer may have his or her life extended by three months by the use of multiple targeted therapy, which can cost more than $10,000 a month per drug. Is that good use of taxpayer money? I shall leave that to the readers to judge. The question for those who answered "yes" is that, what is the opportunity cost for others in giving this patient his/her much-needed targeted therapy drugs?

I think the current approach of using a drug formulary to limit the spending is probably wise. On a side note, none of the psychiatric drugs used currently are "self-financed items". Many are under "special drug" label, but no, patients do not need to pay using these drugs.

Postscriptum. this is a response to "在香港做人,還是仆街到底比較好", Accessed 8 March 2014, URL:

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