Recently Medicare began to explore whether to cover cheaper prostate cancer treatment alternatives, rather than new options that have not been proven to be more effective. In my view this is a perilous decision for a bureaucracy like Medicare. After all Medicare relies on a handful of medical experts who are likely to have a subjective, narrow perspective.
When it comes to the best treatment, effectiveness, like beauty, is in the eye of the beholder. For instance da Vinci robotic surgery does not have a better cure rate than open surgery, and it has not proved to avoid side effects like ED or incontinence better than standard surgery. However it is minimally invasive thereby allowing for less scarring and less pain as well as a quicker recovery, averaging one day less in the hospital than open surgery.
Robotic surgery also allows the vast majority of patients to recoup their energy within a couple of weeks, rather than an average of six weeks after an operation. In turn this affects patients' going back sooner to work routines in a more productive manner.
So while robotic surgery was once a new treatment option, if it or a newer modality were judged to be no more effective than other current treatments, strictly in terms of offering the same cure rate, so many significant additional benefits would be denied in the name of effectiveness.
Determining the effectiveness of a new treatment most likely would be wrongly based solely on limited, though important criteria like equal cure rates or, for that matter, equally onerous side effects such as ED and incontinence rates.
Comparisons with open surgery as well as with different forms of radiotherapy that incur different price points tend to be invidious. This is the case especially when such comparisons don't take into account the fine-tuned, but significant enhancements of newer treatment developments.