A blessing for a sick girl is a dilemma for a country

If you want to look into the hard questions that need to be answered before this country lurches headlong into nationalized health care, check out this front page article in today's Boston Globe about a very ill girl with Gaucher disease in Costa Rica:

For Jose and his family, it was as though a hand had reached down to answer their prayers. But in that moment, something else had happened as well: The Cambridge drug company Genzyme had just found its first potential patient in Costa Rica. And now that it had found one, it would supply the drug to Tania, but at an astonishing cost - $160,000 a year, possibly for the rest of her life.

This was far more money than the Costa Rican government had ever paid for a drug, and Genzyme would not bend on the price. The country's health officials were forced to weigh the prospect of a healing gift for one girl against the needs of a nation struggling to care for millions.

Should Tania get the drug?

Costa Rica's health board decided "no".

Costa Rica's healthcare system was considered a success story, and it was succeeding not because it spent freely, but because it spent carefully. The challenge of paying for Cerezyme, a product at the extreme high end of the brand-name drug business, was something new.

Inside the health ministry, a committee of doctors met to decide Tania's case. They reviewed the medical literature on Cerezyme's effectiveness - whether all patients clearly benefited (they don't) and whether Tania would, which was uncertain. In the end, the committee voted, unanimously, to deny the payment.

"We have 600,000 hypertensive patients, 120,000 diabetics," said Chaves in an interview. "That's where they set the priorities."

With help from the American drug company (Genzyme) the Gonzalez family sued the government:

The case reached Costa Rica's constitutional court in July 2003, and the results were swift. At the hearing, Dr. Saborio testified about Tania's diagnosis; he said she definitely had Gaucher disease.

"They asked me what her future would be if she didn't receive the medication. And I told them exactly what would happen: eventually she would die," said Saborio. "And that was it . . . I think there was little doubt about what the right decision was."

It took an hour. The court told Costa Rica that Tania would get her treatment, and Genzyme would get paid.

A happy ending for Tania, to be sure, but there's always the question of how finite resources might have been spent for the rest of the Costa Rican population.