Cell Culture Drug Resistance Testing (CCDRT) Cell Death Assays:
Misconceptions Versus Objective Data
Cost benefit considerations relevant to third party payment
Lastly, I should add one additional point. As a board-certified medical oncologist myself who well understands the difficulty in treating cancer patients, I have intentionally not attempted to defend the use of these assays on the basis of cost-effectiveness. We are living and working in an area in which many managed care decisions are made with regard to cost. It is obvious that the identification of curative chemotherapy is a cost-effective endeavor. However, sub-curative cancer treatment is a money-losing proposition. The longer a cancer patient lives, the more medical care he or she is likely to receive, and the greater will be the cost. My personal opinion is that the appropriate use of these assays could be very cost effective (e.g. as also suggested in a recent published analysis: Mason,JM, et al. Int J Technol Assess Health Care 15:173-84,'99), but that, in the real world of today, the use of the assays could well drive up costs, both in payment for the services in and of themselves, and in the additional costs associated with adding on months or years of life to patients with treatable but incurable cancer. From the point of view of the insurance company, these tests can be a lose/lose proposition. On one hand, they may fail to identify an active treatment, which means that the insurance company must pay for the test. On the other hand, they may identify an active treatment, in which case the insurance company must pay for both the test and pay for medical care for additional months or years of life. It is a dreadful secret but obvious truth that insurance companies would prefer for their cancer patients to just hurry up and die without receiving effective treatments which would prolong their lives and allow them to consume more of the insurance company's resources. But an insurance contract is a two way deal. The patient pays his premiums and the insurance company provides benefits that the patient needs in order to stay alive. Or that is the way that the patient expects that the two way deal will work. It is a terrible thing when the company reneges. Or when the country reneges, in the case of Medicare.