Should we stop costly treatments to reduce the high healthcare costs?

André den Exter

Healthcare expenses have been skyrocketing for years and will continue to increase. According to the Report Toekomstverkenning Zorgkosten 2022, the costs will have increased in 2060 from 100 billion euros to 291 billion euros a year. This trend must be changed to be able to maintain our healthcare system. To do so, difficult choices must be made. André den Exter, Associate Professor of Health Law at Erasmus School of Law, looks in an opinion article into the option to no longer pay for certain expensive cancer drugs and costly treatments. 

Currently, our healthcare system uses certain cancer drugs and treatments that cost a lot of money. "You can think of precision drugs for late stages of metastatic cancer. This promising treatment method (immunotherapy) is in addition to current methods (radiotherapy and chemotherapy) and helps the immune system recognise and attack cancer cells. The costs of certain treatments are extremely high and vary from a hundred thousand to over two and half thousand euros per patient annually," explains Den Exter. 

It is not just the extreme costs but also the fact that this treatment is not focused on healing, but life extension continues the health law expert: "This treatment does not heal anyone. It extends the life of someone for a couple of months, sometimes one to ten years. An uncertain factor is how these immune cells behave in relation to the mutating cancer cells in the long term." 

According to Den Exter, it is an option to let no longer insurances pay for these expensive drugs. A less radical decision would be to ration immunotherapy and thus offer the treatment to a smaller group of patients. This alternative would mean that doctors have to choose who (not) to give the medicine, explains Den Exter: "selection is therefore inevitable. Doctors have to make difficult choices. A possible selection criterium is the response to genetic prognosticators, biomarkers, and how someone will react to a certain treatment." According to Den Exter, many would plea for the treatment of the ones that react the best to this treatment, but "who decides that? The added value of an extra month of life differs for everyone (the birth of a grandchild or children's wedding). The introduction of immunotherapy awkwardly exposes how difficult the rationing issue in healthcare is", says Den Exter. 

No medical matter 

"Selection of patients can not solely be based on medical grounds", emphasises Den Exter. "Other non-medical criteria like genetic predisposition, costs, age, and social factors equally play a role in the appointment and thus the treatment payment. Rejection irreversibly means the death of a patient." 

Especially concerning non-medical grounds, Den Exter sees opportunities for politicians to develop standards. "Because it concerns non-medical criteria to decide whether to pay for treatment, there must be a political debate. In this case, about the acceptability of certain criteria for immunotherapy for metastatic types of cancer", pleas Den Exter. All these non-medical questions are legal, ethical or social issues and can therefore not directly be answered using the medical expertise of doctors. 

Den Exter has a clear message for the Minister of Healthcare Ernst Kuipers: "Hearing different opinions is necessary to make political choices in healthcare and to draft selection criteria. Minister, give doctors the tools to decide in individual cases." 

Associate professor
More information

Read the entire opinion article in het Nederlands Dagblad here (in Dutch).

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