Letters to the Editor

Longer Life, at What Price?

Editor's note: The following editorial appeared Sunday in the St. Louis Post-Dispatch.

Americans' average life expectancy increased by about six months between 2000 and 2005. That progress came at the cost of $630 billion. Is that a good deal?

A study published last month in the journal Health Affairs takes a sophisticated look at the relationship between increased health care spending and longer life. Researchers examined changes in spending on seven common illnesses between 2000 and 2004, tracking the relationship between those changes and reductions in mortality from the illnesses.

Their study is part of a wave of new research designed to answer some surprisingly basic questions about medical care. Most Americans got a brief, distorted glimpse of that research during the health care reform debate last year -- remember the talk about "death panels" and comparative effectiveness research? But basic questions about what we spend and what we get seem simple to ask but are difficult to answer.

How much do you value an extra year of life? If you're looking for an absolute dollar figure, you're out of luck. The new study wasn't designed to dictate what we should spend. But other researchers have proposed figures ranging from about $50,000 to $7 million for working-age adults.

How did we do? The new study showed that for patients with sepsis, a systemic blood infection that's often fatal, each additional year of life cost between $100,000 and $194,400, depending on the patient's age. In comparison, heart attacks ($12,000 to about $98,000 a year), stroke ($26,000 to about $42,000 a year) and pneumonia ($10,600 to $15,700 a year) are relative bargains.

As those figures suggest, the new study "found that health care dollars produce inconsistent value."

That squares with the results of a longer, more comprehensive study published two years ago in the New England Journal of Medicine.

It examined spending and increased life expectancy between 1960 and 2000. For the most part, the authors concluded, increased health care spending has been a bargain. But it found "a sharp increase in the cost per additional year of life gained during the past two decades, primarily among the elderly." Those costs rose from $46,800 to $145,000 between the 1970s and 1990s.

Is there a point of diminishing returns, a juncture in which more spending per year of life gained is simply too much to justify?

Americans have avoided answering, or even contemplating, such a question.

How long we can continue to do so remains to be seen.

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