April 23, 2024

Utility or happiness? A case study from Detroit

Is a cataract operation on a dying man worth the candle?

Here’s an interesting case which illustrated the difference between health care in the US and UK. Detroit resident Vincent Thomas, 58, was battling multiple myeloma, and only had a few months left to live.

And worst of all, he was nearly blind because both of his eyes were screened by cataracts. He asked his doctors if they would authorise an operation to remove the cataracts. He was stopping his cancer medication and going into hospice care anyway, but he wanted desperately to see his family before he died.

There was an uproar at the clinical meeting at Michigan Medical. According to his ophthalmologist, Julie Rosenthal:

Our anesthesiologist and others on the operating room team were opposed to performing a surgery on a patient on hospice with only weeks to live. The anesthesiologist was trained in Britain and noted that Thomas' cataracts would never be removed there, where committees decide on the utility of certain treatments and procedures. For someone who would only get a few weeks of “use” out of his surgery, the costs couldn't be justified. Thomas' oncologist was concerned about his health and had a serious discussion with him. However, Thomas understood the risks and decided it was worth it to undergo the surgery.

The surgery went well. Mr Vincent regained his independence and was able to drive to see his relatives. He died a few months later.

Dr Rosenthal asks whether the right decision had been made. She argues that it was. Compared to the huge amount spent on treating resistance multiple myeloma, it was “chump change”.  Treatment for the disease and the side effects can cost US $125,000 to $256,000 per patient. Cataract surgery costs about $3000. She writes:

We make heroic, costly efforts to prolong life, but what about treatments that improve life, that make people's last days better and allow them to finish their days in a meaningful way?

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cost benefit analysis