A sad and disturbing story in today's WSJ about a hospitalized patient with a rare disease that racked up huge drug costs:
August 2, 2001
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One Patient, 34 Days in the Hospital,
$7,000 Syringes and a $5.2 Million Bill
By RON WINSLOW
Staff Reporter of THE WALL STREET JOURNAL
DURHAM, N.C. -- Stephen Dedrick, chief of pharmacy at Duke University Medical Center, returned an urgent beeper message from his office one Friday morning to hear a startling report: His department had just ordered $250,000 worth of one drug, for delivery overnight from California. It was for a single patient. And it would last only through the weekend.
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Even by the standards of the country's high-tech, high-cost health-care system, what followed was an extraordinary episode in American medicine. Over 34 days of treatment, the patient ran up a bill of $5.2 million. More than 95% of it was for drugs.
The patient, 69-year-old retired prison guard Slim Watson, had developed a rare disorder much like hemophilia. The only remedy was a complex regimen of blood proteins and other drugs that doctors hoped would halt his internal bleeding and restore his blood's ability to clot. Within days of his admission to Duke's 16-bed intensive-care unit, Mr. Watson was going through IV bags of clotting factor at a rate of $30,000 every four hours. The staff started calling him the million-dollar man.
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The blood-factor treatment was stopped, and Mr. Watson was put on sedatives to ease his discomfort. On the afternoon of Nov. 13, with several of his family members at his side, he smiled and blinked. "Finally, he just closed his eyes," Mrs. Watson says.
In the end, what made the case so costly was the persistent uncertainty of its outcome. If Mr. Watson had been dying of another disease, use of blood factors probably would have been much more limited, his doctors say. If he had responded quickly, as often happens, he wouldn't have needed so much of them. For most of his stay, he was neither dying nor getting better. "Fifty-fifty cases are the toughest and most expensive to be in," Dr. Kussin says.
"As a business decision," treating Mr. Watson "wasn't a great one," Dr. Kussin concedes. He notes that "our hospital has always told us to spend what we need to take care of people." But as a physician who has also served as a senior administrator, he says, "This amount of money has never been put on the table before for one patient. When does a hospital have the right to say, 'Time out'?"
Duke's insurance reimbursement from Medicare, plus a private plan, was $2.5 million. Hospitals have to accept this as payment in full. The family wasn't billed. In the end, owing to the complex way Duke bills for overhead and other expenses, it says it took a loss of $800,000 on the case.
The charges on the bill included $1.9 million for NovoSeven and $2.9 million for Hyate:C, the factor made from pigs' blood. Ipsen says it sold U.S. hospitals 10 million units of Hyate:C last year for 163 patients. More than 980,000 of those units, nearly 10%, were given to Mr. Watson alone.
Duke's final bill ran to 45 pages. The column where the charge for each item appeared wasn't wide enough for numbers higher than five figures and two decimal points. Daily six-figure charges for blood factors ran over into an adjacent column.
On the last page, the total reads: $214,333.50. The "5," as in $5 million, doesn't appear. The format couldn't handle a number that large.
Write to Ron Winslow at ron.winslow@wsj.com
Full story at:
interactive.wsj.com
Such stories are I'm afraid going to become more common - the US medical system is understandably uncomfortable with medical rationing where someone's life is at stake. I can't say I can offer any sensible answer as to what to do in such situations.
In a previous era, an analogy was dialysis. There weren't enough machines, and selection committees had to choose who would live and who would die. The legislative response was to guarantee dialysis for everyone. That solved the moral problem, but we now have vegetables being dialyzed.
Peter |
