Re: Spending $93,000 for 4 months

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Pardon the slight amendment of the thread name. When the median and the mean deviate by a large margin, then one should not attempt to learn much, statistically, from the Normal Distribution. Sometimes the Poisson Distribution describes the sample space adequately, but otherwise one should resort to the Binomial Distribution. Using a statistical sample having divergent median and mean does not prevent one from calculating other statistical factors, but those must be regarded as highly suspect.On Apr 2, 2011, at 3:02 PM, ProstateCancerSupport wrote:From: Nowak <tnowakgmail>Subject: Re: Spending $93,000 to extend life four monthsTo: ProstateCancerSupport Date: Thursday, March 31, 2011, 3:15 PM We need to clarify some issues in this conversation. The first is the common, but significant error about the survival advantage that Provenge can provide. The 4.2 month survival is the median, not the average as was mentioned. The difference between the median and the average can be very significant. One calculates an average by adding together all the numbers, in this case the survival times of the men in the trial and dividing it by the number of subjects. On the other hand a median is not calculated, it is the score directly in the middle of all scores. So, if 101 men received Provenge and 50 of them died one week after the treatment was given to them, 1 man died at week 3 and the remainder 50 men died 10 years after the treatment the median is only 3 weeks. Using these same figures the average would be 257.9 weeks of survival. Does saying that the survival advantage is 3 weeks (that is the median) really reflect the reality of the situation? I don't think so. If you take the same example, but instead the 50 men on the right side of the curve died 20 years after the treatment the median (the measure that we are using) remains 3 weeks!Then compound the fact that the clinical trial for Provenge allowed a crossover. This means that men who received placebo were offered Provenge when they showed signs of disease progression. Even though these men did get Provenge (and probably also had a life extension advantage from the treatment) they were considered to be a part of the placebo group for the purpose of calculating survival numbers.Statistics are only a way to describe a group trend, they never describe the experience of the individual. You can not use statistics to know what your individual fate or experience will be in the future. Then there is the issue that is raised about the cost of Provenge. Provenge is not more expensive for the median month of additional survival than is taxotere. Taxotere, the drug, does cost less than Provenge. However the side effects and toxicities of Provenge vs. taxotere end up at at least balancing the monthly life extension cost differential. Taxotere comes with many additional costs including the supportive medications that are required to deal with the blood problems, nausea and the required steroids. Added to that taxotere usually requires some emergency room visits and hospitalizations. The usual additional costs of Provenge might be an aspirin or Tylenol. None of these costs factor in the cost of human suffering and mental distress. All the chemotherapy drugs are toxic. If you put poison into your body your body will suffer, Provenge causes nothing more than flue like symptoms for a few days. On Thu, Mar 31, 2011 at 12:52 PM, <djmarchand> wrote: Medicare has just approved reimbursement of $93,000 for a course of treatment with Provenge which has been shown to extend the lives of HT resistant PCa patients by an average of four months.Now if I was one of those patients, I would want the drug if it were provided free by Medicare. But as an American who pays for that treatment with taxes and insurance premiums I don't think it is worth it. This treatment wouldn't meet the criterion of Great Britain's NHS and I suspect that it doesn't qualify in other Eurpean countries (anyone know?), so why pay for it in America?And twisting my decision another way, if I had HT resistant PCa and given my current financial resources, I wouldn't pay for it out of my own pocket, which I could. I would want my wife and kids to get that money, not waste it on an extra four months of my life. Tough call but that is how I feel now (but with PCa a distant memory).We are going to have to make some tough choices to reign in our country's health care cost and this is one of them. The medical industry can and will develop more expensive treatments than we as a society can afford to pay for.What do you guys think?-- T Nowak, MA, MSWDirector for Advocacy and Advanced Prostate Cancer Programs, Malecare Inc.