Should “we” prefer more expensive medical treatments?

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 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.


One thought on “Should “we” prefer more expensive medical treatments?

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