Medicare decision only first of many tough questions

What is a month of life worth?

Medicare isn't supposed to take cost into consideration, but Wednesday's recommendation that a new vaccine for men with advanced prostate cancer be approved has raised that question.

The 14-member Medicare Evidence Development and Coverage Advisory Committee said that Provenge, which was approved in April, could help extend the lives of patients with advanced prostate cancer.

The problem is, the treatment costs about $93,000 per patient and has been shown to extend patients' lives by about four months.

Men tend to be elderly when they get diagnoses of prostate cancer, and more and more are choosing to do nothing about it -- some say more men die WITH prostate cancer than die OF it.

Still, it strikes about 192,000 American men each year, and kills about 27,000. Surgery, radiation, hormones and chemotherapy are the only treatment. Provenge, which was rejected for approval in 2007, is different from standard vaccines, which are given before someone gets sick to stimulate their immune system to fight off infections, in that it is a "therapeutic vaccine" designed to attack cancer cells in the body.

Medicare's decision is important, because private insurance companies generally follow its lead.

But Provenge isn't alone in being a costly cancer treatment. Cancer drugs, measured by how much they cost to prolong a good quality of life for one year, include Avastin for lung cancer, which costs $1.2 million, Tarceva for the pancreas, which costs $659,772; Erbtiux, lung, $401,760; Provenge, prostate, $272,000; Nexavar, renal cell, $147,634; Ixempra, breast, $147,520; and Alimta, lung, $97,555 according to the Washington Post.

It's easy to choose such expensive treatment when "somebody else" is paying for it, but the truth is, we're all paying for it.

As healthcare reform throws more medical questions into the fiscal arena, we as a nation will be forced to make more tough decisions, such as how much a month of life is worth.