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April 2018

The Trade-offs When Focusing on the Mortality Benefit

Author Affiliations
  • 1University of California, San Francisco, San Francisco
  • 2Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts
  • 3Health Care Policy and Law Editor, JAMA Internal Medicine
JAMA Intern Med. 2018;178(4):455. doi:10.1001/jamainternmed.2018.0067

There is growing evidence that patients have varying priorities at the end of their life. Some want to focus on maximizing their quality of life, whereas others focus on living longer.1 Current clinical practice prioritizes the latter. For example, most cardiac device trials use overall survival as the primary outcome, instead of quality-adjusted life years (QALYs).2-4 What is left unsaid is that these mortality benefits often come at a cost: discomfort, loss of mobility, polypharmacy with its attendant adverse effects, procedural complications, device failure, or loss of functional status.