Expensive Cancer Drugs: A Comparison between the United States and the United Kingdom
Expensive Cancer Drugs: A Comparison between the United States and the United Kingdom
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DOI：
10.1111/j.1468-0009.2009.00579.x
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发表时间：
2009-12-01
影响因子：
6.6
通讯作者：
Leider, Jonathon P.
中科院分区：
文献类型：
--
作者：
Faden, Ruth R.;Chalkidou, Kalipso;Leider, Jonathon P.
研究方法：本文介绍了英国和美国的覆盖面，访问和费用分摊政策方面的昂贵的癌症药物，然后比较了11个这样的药物的成本，英国患者，美国医疗保险受益人，美国患者购买的药物在零售市场。三个问题所提出的这些比较，然后审查：第一，哪种制度是公平的？癌症患者在哪个系统中更好？假设没有一个系统可以持续地为每个人提供至少一些昂贵的抗癌药物，用于某些临床适应症，那么每个系统在做出这些艰难的决定时面临哪些挑战？调查结果：在英国和美国的医疗保健系统中，并非所有可能受益于或希望获得昂贵癌症药物的患者都能获得这些药物。在美国，所有的抗癌药物都可以在需要的时候获得，而在英国的国民保健制度中，自上而下的人口配给对英国患者的获得构成了不可逾越的障碍，这两个国家的流行特征与现实相去甚远。结论：英国制度的关键要素比美国制度更公平，而英国的医疗体系在处理昂贵的癌症药物的问题上有着更好的结构。这两个系统在做出这些决定时都面临着共同的道德、财务、组织和优先事项设定方面的挑战。
Methods: This article describes British and American coverage, access, and cost-sharing policies with regard to expensive cancer drugs and then compares the costs of eleven such drugs to British patients, American Medicare beneficiaries, and American patients purchasing the drugs in the retail market. Three questions posed by these comparisons are then examined: First, which system is fairer ? In which system are cancer patients better off ? Assuming that no system can sustainably provide to everyone at least some expensive cancer drugs for some clinical indications, what challenges does each system face in making these difficult determinations ?Findings: In both the British and American health care systems, not all patients who might benefit from or desire access to expensive cancer drugs have access to them. The popular characterization of the United States, where all cancer drugs are available for all to access as and when needed, and that of the British NHS, where top-down population rationing poses insurmountable obstacles to British patients' access, are far from the reality in both countries.Conclusions: Key elements of the British system are fairer than the American system, and the British system is better structured to deal with difficult decisions about expensive end-of-life cancer drugs. Both systems face common ethical, financial, organizational, and priority-setting challenges in making these decisions.