Very high cost treatment for a single individual--a case report.

A Health Authority was requested to fund immune tolerance induction for a young haemophiliac at a potential cost of up to 2 million pounds sterling over a year. The decision-making process adopted included an external review of the case, literature review to establish the evidence base for treatment, and extensive discussions with the clinicians involved. The Health Authority agreed to fund treatment, but with continuous review of the case and explicit criteria for abandoning treatment if it was not working. After 11 months these criteria were met, and the treatment was abandoned. The decision-making process and ethical issues involved in deciding whether or not to fund extremely high cost treatment for an individual patient are discussed. Cases such as this present a stark contrast between rights-based and utilitarian ethical approaches. Primary Care Trusts (PCTs) are more vulnerable (because of their smaller populations and budgets) than Health Authorities were to the financial destabilization that high-cost cases can cause. PCTs are advised to make arrangements to enter risk-sharing arrangements to spread the cost of such high-cost treatments.