Expensive medical treatments have been in the news recently. Medicare questioned whether it should reimburse the costs of a new Alzheimer’s drug. Aduhelm is costly, and there are questions about whether it is effective. It is also not considered safe by some medical experts. The New York Times described the controversy: “Last year, Medicare’s actuarial division, acting without knowing what the coverage decision would be, imposed one of the biggest-ever increases in Medicare Part B premiums for 2022, partly driven by the possibility of coverage for Aduhelm, which at the time was priced by its manufacturer at $56,000 a year.”
In a nutshell, the story shows the problem of how very expensive treatments are paid for. People may require them to stay alive or lead somewhat normal lives. But who should pay for them?
Certain conditions can be much more expensive to treat than others. To identify the most expensive ailment in America, 24/7 Tempo reviewed the cost per case dollars, which measures the amount of money spent per episode of care, for 256 detailed conditions treated in the United States in 2019 from the Health Care Satellite Account, a set of statistics measuring U.S. health care spending produced by the Bureau of Economic Analysis (BEA).
We used the bureau’s Blended Account database, which combines data from multiple sources, including large claims databases that cover millions of enrollees and billions of claims. To concentrate on specific conditions and diseases, we excluded miscellaneous categories, such as “Other care and screening.” Additional data also comes from the BEA.
Although a few of these ailments, including some heart attacks and HIV, are known to be preventable, the majority of them are not. The causes of a wide range of cancers, as well as appendicitis and ulcerative colitis, are variable and poorly understood, meaning that patients may have little control over their progression and hence their need for expensive treatment.
Some of the most expensive ailments, including sickle cell anemia and cystic fibrosis, are hereditary conditions. While living a healthy lifestyle is a key factor in preventing certain medical conditions, it often has little to do with some of the costliest illnesses.
The most expensive medical treatment in America is for cystic fibrosis. Here are the details:
- Cost per episode of care: $136,319
- Annual expenditure on condition: $4,942,155,835 (185th most out of 256 conditions)
- Annual weighted number of episodes: 36,254 (309th most)
- Relative growth in cost per case spending: #1 fastest