Imagine a disease with two possible treatments: Treatment A works OKish people and is cheap (50-500 USD per treatment).
Treatment B works as well as A (studies typically find no statistical difference, if anything B sometimes performs slightly worse), but is 10-100x more expensive than treatment A (1-10k USD per treatment).
Some patients prefer A and other prefer B as the side-effects and compliance requirements are different (none are very serious medically, but cause some annoyances). Some doctors are agnostic between A and B, while others tend to prefer A or B. The doctors who prefer and recommend B will often get some of the extra cash that B generates (but not always).
- Should A be preferred to B?
- Should the extra cost of B be supported by the patient themselves (as opposed to insurance covering both A and B at similar reimbursement rates, private or public)?
- Should B be allowed by regulation?
Now, the hard questions (with comments):
- Does it matter if the disease is “major depression”, A is “anti-depressants”, and B is “cognitive behavioral therapy” (or other forms of talk-therapy)?
This is one specific context in which I keep hearing the argument that “B should be recommended as its as good as A“. It just seems like a very weak argument. SSRIs or other pharmacological anti-depressants should be the default treatment as they have lower costs.
Generic SSRI are about 10$/month: no therapist will give you a comparable rate: in fact, the major cost of generic SSRI therapy is whatever the physician charges to renew the prescription.
Perhaps if the technology for bot-based cognitive behavioral therapy catches up, then CBT may become as cheap as medication.
- What if A is “physiotherapy” and B is “back surgery”?
Same: the cheaper treatment should be the default.