In Economic View – Who Will Determine Who Pays for Equality in Health Care? – NYTimes.com economist N. Gregory Mankiw writes “Not long ago, I read a physician estimated that statins cost $150,000 for each year of life saved.” That number appeared to me to be a wild exaggeration, so I spent 30 seconds doing a google search. The secon result produced an article, “Cost effectiveness of statins in coronary heart disease” from the Journal of Epidemiology and Community Health. I clicked through and read the whole thing (’cause I have access through the university system to this journal) and much of it was epidemiological and statistical, beyond my expertise, but here’s the crux, from the abstract:
“Methods: The review searched for studies comparing statins with no treatment for the prevention of either cardiovascular or coronary heart disease in men and presenting cost per years of life saved as outcome. Estimates were extracted, standardised for calendar year and currency, and stratified by categories of risk, age, and funding source
Results: 24 studies were included (from 50 retrieved), yielding 216 cost effectiveness ratios. Estimated ratios increase with decreasing risk. After stratification by risk, heterogeneity of ratios is large varying from savings to $59 000 per life year saved in the highest risk category and from $6500 to $490 000 in the lowest category. The pooled estimates show values of $21571 per life year saved for a 10 year coronary heart disease risk of 20% and $16862 per life year saved for 10 year risk of 30%.”
If I am not mistaken, the pooled estimate is $21,571 for life year, with costs actually decreasing as the risk increases. In either case, it is clear that Mankiw did not choose his number scientifically, but plunked it from one study. My guess is that the $150K number had to do with the fact that this is the low end of the income for the highest 3%-5% of American households.
I believe that his choice of numbers is not only deceiptful, but disingenuous. I normally read Mankiw and even when I disagree, I can see the logic of his arguments. Not this time…
UPDATE: Mankiw’s numbers are really goofy: check here, or here, or here. This is a very, very, bad example…
From Mankiw’s blog…
Addendum: In case you are curious, the $150,000 figure for statins comes from Abraham Verghese, Professor and Senior Associate Chair for the Theory and Practice of Medicine at Stanford University.
http://online.wsj.com/article/SB10001424052970204005504574235751720822322.html
Thank you for the link. There is no reference in the Wall Street Journal to where that number came from, making it no less dubious. Continuing to publish and repeat deceptions does not make the deception true. Only a conservative serving in the Bush administration (Mankiw) would believe that such an approach approximated objectivity or truth.
I gave references to peer-reviewed, meta-analyses, which is a state-of-the art statistical practice. The readers can choose their source. I will only note that mine was produced by scientific practice, is transparent, and follows a peer-review practice. My invitation is for someone to show me where Mankiw’s number *really* comes from–meaning the study, the research…
I will have to take the time to read them… but I reiterate, those numbers were superfluous. His inaccuracy, if it was an inaccuracy, does little to taint the actual argument. Let’s face it, it’s a pretty obvious argument.
Surely, the cost/price of healthcare (including efficacy) will make some treatments too expensive, but that will happen regardless whether there is health care reform or not. In that sense, the argument is obvious. Although that said, Mankiw’s reasoning about how such decisions are made does not reflect the reality of most human decision making, as any reader of Freakonomics would suggest.
If Mankiw is using his argument to inveigh against the current debate, then this is really an argument that is all smoke and mirrors, meaning he seeks to change the subject and argue something else. In this case, he argues that healthcare will never be equal as an argument against it. Sure, it won’t be equal under any plan, just as its not equal now. But, that is beside the point and it is not what our society is debating.
President Obama is proposing an expansion of access to healthcare (insurance, public option, etc.) and expanding coverage, even if mandated.
For some more interesting reading, I suggest folks read: http://cheeptalk.wordpress.com/2009/09/21/the-price-of-drugs/