Even more telling, an American cancer patient faces the same financial obstacles regardless of how much benefit the cancer drug provides. For example, drugs like Herceptin, that can mean the difference between life and death for some breast cancer patients, can be no easier for American cancer patients to access than drugs like Avastin, which studies suggest has little or no impact on patient survival.

In comparing the two health care systems, though they wish they had more data to work with, the researchers find that the British system is in many ways fairer than the American system and that it is better structured to deal with difficult decisions about expensive end-of-life cancer drugs.

Faden says the notion that every patient should have unrestrained access to every drug available, no matter how unlikely the drug is to help and no matter how modest the benefit, is just not feasible. The problem is figuring out access strategies that work best for most people and that respect the range of values that patients facing serious illness and death hold. "Neither system is well equipped to think through the kind of challenges that all systems confront," she says.

For many people, certain drugs will only extend life for a few weeks or months, and that time can be marked by severe side effects from the drugs themselves, Faden notes. Still, choosing which path to pursue at the end of life is an agonizing decision.

"We're managing health care costs by not allowing some people to be treated at all or forcing them to face financial ruin by getting treatment," she says. "Who has an extra $100,000? That's why people sell their homes. That's why people's kids don't go to college. There's probably no more anguishing kind of decision than what a patient and her family face at the end of life."

Source: Johns Hopkins Medical Institutions