For the very ill, legally ending life is increasingly costly

The price of one popular drug prescribed under the state’s 2008 Death With Dignity Act increased roughly $2,500 over seven years.

“As a medical oncologist, I see patients who request death with dignity medications quite frequently,” said Dr. Veena Shankaran, of the University of Washington and the Fred Hutchinson Cancer Research Center in Seattle.

“There was one instance when a patient of mine asked how much it was going to cost, and I had no idea,” Shankaran, lead author of a paper in JAMA Oncology, told Reuters Health.

To examine the price of the medications, Shankaran and colleagues examined the 73 death with dignity prescriptions written and dispensed since 2010 at the Seattle Cancer Care Alliance.

The sedative secobarbital, branded as Seconal, made up nearly half of the prescriptions. But the average cost of secobarbital increased from $388 in 2010 to $2,878 in 2016, according to the researchers.

Pentobarbital, another sedative, accounted for 30 percent of the prescriptions, but its use dropped after its manufacturer stopped selling the drug to keep it from being used in state executions. Its average price remained steady at $350 when it was prescribed from 2012 to 2014.

Shankaran’s team reports that due to the increasing cost of secobarbital in 2015 and 2016, 16 patients at Seattle Cancer Care Alliance were referred to a compounding pharmacy that created a lethal drug cocktail for $500.

It’s uncommon for insurance companies to pay for these drugs, said Shankaran. Patients would need to pay out of pocket.

“Honestly, I really think it’s just pharmaceutical companies jacking up the price of the drug,” she said. “I don’t see another explanation for it.”

Valeant, which manufactures Seconal, released a statement in March after California passed its own death with dignity law in 2015 and questions arose about the drug’s increasing cost.

At the time, the company said a drug’s price is based on a number of factors. Those include “the development or acquisition of a drug, the availability of substitutes or generics, and the benefits it offers versus alternative treatments that might be more costly.”

Shankaran said people who choose death with dignity don’t have much of a voice since they are sick and close to the end of their lives.

Also, she pointed out, people with cancer who choose death with dignity have already spent a lot of money on other treatments and care.

“We do need to shed light on this in hopes that there will be some regulation over this,” she said.

SOURCE: bit.ly/2ekESnG JAMA Oncology, online October 6, 2016.