Medical Breakthroughs Will Extend Lives, But at a Cost

MONDAY, Sept. 26, 2005 (HealthDay News) -- Emerging biomedical technology may be a double-edged sword, simultaneously resulting in healthier, longer lives while also fueling Medicare spending.

And, with the exception of obesity, curing any one disease won't save Medicare money, a new report finds.

"As we strive for the magic bullet or infinite life expectancy, we need to understand that health-care costs will go up in order to achieve this, and they will not go down," said Dr. Mark Fendrick, professor of internal medicine and health management and policy at the University of Michigan School of Medicine.

Added Dana Goldman, corporate chair and director of health economics at Rand Corp. in Santa Monica, Calif.: "If just a few of the promised technologies come on line, then Medicare and the entire society could face substantially increased health-care spending. We need to worry not only about the demographic risk [posed by the aging of the baby boomers], but also the risk of developing new technologies that appear to break the bank."

Goldman was lead author of a series of articles detailing the potential cost of new technologies that appears Monday in a Health Affairs Web exclusive.

The number of Americans aged 65 and over is projected to double by 2030. At the same time, scientists are actively engaged in finding panaceas for a range of ills that ail us.

As currently projected, Medicare spending will soar from 2.6 percent of the gross domestic product today to 9.2 percent in 2050. Medicare, the federal government's health-care plan for the elderly and disabled, is already the single largest source of health-care spending in the United States, the study authors reported.

Goldman led a team charged with seeing how changes in medical technology, disease and disability would affect future health spending for the elderly.

To do this, the researchers developed the Future Elderly Model (FEM), using a representative sample of about 100,000 elderly Medicare beneficiaries, to help predict future costs and the health status of the elderly.

The lead article focuses on how 10 technological advances in cardiovascular disease, neurological disease and cancer and the biology of aging would affect lifespan and spending in the period from 2002 to 2030.

If half of elderly patients with new cases of heart failure or heart attack were to receive implantable cardioverter defibrillators (ICDs), for instance, total treatment costs would rise to $27 billion in 2005 dollars.

Anti-aging technologies -- such as a drug to limit calorie intake, which some scientists believe could add years to the lives of even healthy people -- would increase health-care spending simply by increasing the number of people who live to become old.

Such a compound would increase spending allocated to health care by 14 percent in 2030, largely because it would result in 13 million more Medicare beneficiaries. The cost per additional year of life would work out to $11,000, a modest sum, according to the study authors.

If the compound only kept people alive in poor states of health, the cost per additional year of life would be $38,000, still a relatively modest amount.

One important question is who would use the technology. "How do we make sure that we get the technology in the hands of the patient for whom it's most valuable?" Goldman said. "The general story for all of these things is they get really expensive when you start doing them for large swaths of the patient population."

Another question is how to change incentives for developing the technologies in the first place. "In the automotive and consumer-electronics industries, there are incentives to develop good, cheap DVD players or good, cheap cars," Goldman said. "When it comes to medical technology, there is no incentive to develop something that's pretty good but less expensive because the people who are buying it don't pay for it. It's not surprising that everyone wants a Cadillac instead of a Hyundai."

A second article concluded that curing obesity -- by preventing weight gain in youth -- would save substantial amounts of taxpayers' money.

Currently, obesity accounts for at least $90 billion in direct health-care costs in the United States every year. Obese people will incur almost $40,000 in additional health-care costs over their lifetime.

Beginning at age 70, a person who is obese will cost Medicare about $149,000 over the remainder of his or her life, which is the highest level of any group covered by the insurance program. Medicare spending on an obese person is also 20 percent higher than for the next closest group -- the overweight -- and 35 percent higher than spending for people of normal weight.

What all this means, said Michael Chernew, professor of health management and policy at the University of Michigan School of Public Health, is that Americans need to prepare to spend more money and need to design health insurance products that make sure the new technologies are targeted to the right people.

"The challenge is to understand that not all medicine is life-saving medicine. We as a society need to think about how we want to limit access to things that we might perceive as discretionary," Chernew continued. "A lot of people don't have coverage for chiropractor care and we don't seem to think that is a disaster. It's crucial to give people essential care, but defining that is easier said than done."

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