Medicare: Easy way to cut

iVillage Member
Registered: 10-25-2006
Medicare: Easy way to cut
64
Sat, 07-02-2011 - 9:14am
This is absurd....spending $93,000 to extend the life of a very sick person only 4 mos.

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From Medscape Medical News CMS to Pay for Provenge for Metastatic Prostate Cancer

Nick Mulcahy

June 30, 2011 — In a final decision memo, the Centers for Medicare and Medicaid Services (CMS) announced today that it will provide coverage for the use of Provenge (Dendreon), the prostate cancer vaccine known generically as sipuleucel-T, in patients with asymptomatic or minimally symptomatic metastatic castrate-resistant prostate cancer.

"We are optimistic that innovative strategies may improve the experience of care for our beneficiaries who have cancer," said Donald M. Berwick, MD, administrator of CMS, in a press statement about the coverage decision of the unique treatment, which is derived from a patient's own white blood cells. "CMS is dedicated to assuring that these patients can seek the treatments they need in accordance with their wishes."

The announcement means that the coverage decision is in keeping with the US Food and Drug Administration's (FDA's) indication for the vaccine.

"CMS is covering Provenge nationally only for those indications supported by evidence and consistent with the FDA label," said Patrick Conway, MD, chief medical officer and director of Office of Clinical Standards & Quality at CMS.

Off-label usage will not be covered nationally but instead will be left for local Medicare administrative contractors to decide upon, according to CMS.

Off-label usage is likely to be highly scrutinized. "We do not believe there is any persuasive evidence for the off label use of sipuleucel-T at this time," reads the National Coverage Decision memo from CMS.

The new coverage decision comes after an unusually protracted review by CMS of Provenge, which costs $93,000 for a typical course of 3 treatments.

The vaccine was subject to a CMS National Coverage Analysis, which included a review by a federal panel known as the Medicare Evidence Development and Coverage Advisory Committee.

In November 2010, the committee gave what amounted to a middling vote of confidence for the on-label use of Provenge and a rejection for off-label use.

The combination of the high cost of Provenge and an atmosphere of high-intensity federal budget scrutiny contributed to widespread news coverage of the therapy and the CMS review.

However, there have also been questions about Provenge data because of potential confounding effects of subsequent treatments of some patients in clinical trials. In a technology assessment quoted in the CMS decision memo, the assessment authors noted that the benefit from Provenge occurred in clinical trials that included chemotherapy. "This treatment effect occurs in the context of use of post-progression chemotherapy," the document reads.

Although referred to as a vaccine, sipuleucel-T is actually an autologous active cellular immunotherapy, which means that it is made from the patient's white blood cells and stimulates a patient's immune system to respond against the cancer. The treatment needs to be manufactured individually for each patient.

Sipuleucel-T was the first product approved by the FDA in a new therapeutic class known as active cellular immunotherapies.

In a pivotal phase

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http://www.pnhp.org/news/2009/october/meet_the_new_health_.php

http://www.youtube.com/watch?v=DQTBYQlQ7yM

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iVillage Member
Registered: 02-05-2011
Wed, 07-06-2011 - 12:39am

iVillage Member
Registered: 10-25-2006
Wed, 07-06-2011 - 7:33am

I posted that it would be letter to let the senior die--4 mos. earlier than he otherwise would have--than to let a 5 yo go without the basic necessities.

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http://www.pnhp.org/news/2009/october/meet_the_new_health_.php

http://www.youtube.com/watch?v=DQTBYQlQ7yM

iVillage Member
Registered: 05-13-2009
Wed, 07-06-2011 - 8:54am
\Can you point out where Ezekiel Emanuel wants seniors to die without the distortions of the Betsy McCaughey?

I did a quick look for Bodenheim and there seems to be a Thomas Bodenheimer who writes about health care from the liberal perspective. I did not see anything in the search about throwing granny under the bus. Can you point to his positions?
iVillage Member
Registered: 03-30-2007
Wed, 07-06-2011 - 8:58am
r3dx1 wrote:

iVillage Member
Registered: 11-27-2009
Wed, 07-06-2011 - 9:59am
I know what you said.
iVillage Member
Registered: 11-27-2009
Wed, 07-06-2011 - 10:01am
Because they are willing to allow the government finance their children's welfare.

iVillage Member
Registered: 03-30-2007
Wed, 07-06-2011 - 10:37am

And if parents turned their children over to Foster Care because they can't afford them,

iVillage Member
Registered: 10-25-2006
Wed, 07-06-2011 - 1:15pm

Good.

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http://www.pnhp.org/news/2009/october/meet_the_new_health_.php

http://www.youtube.com/watch?v=DQTBYQlQ7yM

iVillage Member
Registered: 11-27-2009
Wed, 07-06-2011 - 1:40pm
I don't base my opinion on this subject with Betsy McCaughey's position. She is not a source I used to develop my thoughts on this issue. I will point out that what McCaughey's issue was the provision for payment for end-of-life care counseling in the health care reform act. There were misleading statements made, but she also raised some valid concerns.

I doubt you'll find anything about Emanuel or Bodenheimer throwing granny under the bus. That really isn't the issue in an honest debate and sources that use that rhetoric would not be helpful to me. (thank you for finding the correct name)

Based on the rhetorical language used, the introduction of McCaughey into the debate, and the assumption that she is my source for my opinion, I would like to tell you that you are off base.
I am not in complete disagreement with Emanuel. He and his wife have been writing about end-of-life care issues for decades. He is absolutely correct that it is an issue that needs more attention. I think we differ a bit on how to get there, but probably not by any great differences.
Where I differ with Emanuel and others is when there is talk of whether or not a life is worth the expense. The argument put up here is irrelevant; money saved by not treating an elderly cancer patient that would only extend life, not cure the disease would not be then spent on a 5 year old basic necessities, and nor should it. While Emanuel has never to my knowledge used quite an extreme argument for the denial of care, he has made similar suggestions, he has just kept in the scope of health care. ie. money spent on a young patient that has years to live vs. money spent on an elderly or fragile patient that has limited time left.
Medicare is an issue. Just as with any universal health care system that is funded or partially funded by the government, cost containment for Medicare administrators is a major challenge.
I am concerned by those that think the government should have the authority to determine what the cut off is for treatment. I can really only speak for myself, but I think that most people are ok with limits on experimental treatment and non-evidenced based medical treatment. But when these determinations are based the worth of someone life, the amount of life that may be left, that is more than uncomfortable. I am concerned that when we give the government one seemingly minor authority, it will slowly and incrementally develop into something completely unacceptable and intrusive. That's what we have now with the health care reform. It will continue to morph until it is precisely the type of program Obama envisions and spoke of back in the 90's when he said that change will not come in one full swoop, and it takes years to realize through small changes. It's not an accident that most major changes were delayed in the plan.
The issue is multifaceted, and making it singular does not adequately address the problems we have in health care. Limiting care based on age and projected outcome is dangerous. It quickly becomes a slippery slope with flexible and ever adjusting perimeters. Cost containment is a valid issue, and needs to be addressed entirely, not piece meal, and not with emotional rhetoric as in "death panels", "throwing granny under the bus" and denying "basic necessities to 5year old's in favor of an elderly patient with limited life".

iVillage Member
Registered: 11-27-2009
Wed, 07-06-2011 - 1:42pm
How to assist parents with 5 year olds that are unable to provide the necessities for them is another issue and should not be used as emotional rhetoric to validate limiting care for health care consumers.

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