Patients value metastatic cancer therapy more highly than is typically shown through traditional estimates.

There is a growing emphasis on promoting medical treatments that provide the most benefits relative to their costs. However, objective criteria for determining the value patients receive from treatment are lacking. This study used data on the treatment choices of terminally ill patients to estimate the value they associate with care. We found that patients place high valuations on metastatic cancer therapy--on average, twenty-three times higher than its cost--and that other traditional methods used to estimate the value of these treatments for patients significantly undervalues how patients view them. Our methods provide another framework for an evidence-based approach to assessing the value of treatments for terminal illness.

The Frequency, Severity, and Economic Consequences of Musculoskeletal Injuries to Firefighters in California.

The most common work-related injuries among firefighters are musculoskeletal disorders (MSDs). The strict physical demands of the job and limited modified work opportunities suggest that MSDs are potentially more disruptive and costly to firefighters than to others. The importance of understanding the frequency and severity of firefighter MSDs has become heightened due to changes to the California workers' compensation landscape since 2004, including the reduction of permanent-disability ratings that occurred due to the adoption of a new disability rating system and new rules for apportioning disability with respect to job-related causation, the adoption of treatment guidelines to provide utilization review in workers' compensation medical care, and the imposition of caps on the number of times injured workers can be reimbursed for use of chiropractic care and physical therapy. Each of these could have a potentially disadvantageous and disproportionate impact on firefighters with MSDs. This article describes the average frequency and severity of work-related MSDs experienced by California firefighters; examines the impact of work-related MSDs on the firefighters' earnings and employment several years after injury; evaluates the reforms' impact on the ratings of firefighters with permanently disabling MSDs; and assesses whether reforms to the medical delivery system affected the employment outcomes of firefighters with MSDs.