January 15, 2003

Lung Cancer Screening at Any Price?

Author Affiliations

Author Affiliations: Department of Medicine and Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.

JAMA. 2003;289(3):357-358. doi:10.1001/jama.289.3.357

Most biomedical research focuses on the quest to discover new methods for reducing morbidity and mortality from serious illnesses. Once these interventions are created and developed, the next steps in science are directed toward confirmation of the efficacy and effectiveness of these interventions and then estimating their potential impact. On some level, for most investigators, this represents the be-all and end-all of research.

The last decade of medical practice and the changes that have occurred have led to a dramatic alteration in how clinicians perceive the utility of these interventions. No longer is it sufficient that a medication or procedure prolong life or even cure the patient. Today, medical costs also play a role in assessments and judgments of what interventions to use and under what circumstances to use them. In an era of limited resources, these judgments enable physicians to choose among interventions based on these considerations. Expensive drugs or treatments that cure a few individuals may not stand up against less effective but cheaper programs that can cure many. Because of this focus on the societal benefits of therapy, cost-effectiveness has become an important, even crucial, part of health policy decision-making with regard to the use of expensive, or even inexpensive, treatment modalities.14 Hence, from a health policy perspective, a cost-effectiveness policy regarding testing and preventive treatment options may save millions of dollars each year on the costs of introducing highly expensive, but marginally effective, technology.

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