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Economic aspects in prolonged life sustainable treatments.

In a context of limited resources and continuous increase of healthcare expenditures, policy makers need to carefully evaluate the economic impact of their decisions. In the last decade economists have been particularly productive in offering to the decision makers a set of tools able to compare costs and benefits of each single medical procedure. The underlying assumption is that it is not acceptable the investment of considerable amounts of resources in medical procedures able to guarantee only limited improvements in health outcomes. In this particular type of context, an open issue is represented by the delicate topic of the provision of prolonged life sustaining treatments (PLST) to patients in vegetative state. The author, sustains that the provision of this type of treatments can be justified under a mere economic perspective. The traditional economic evaluations focus their attention only to the concept of incremental absorption of resources failing to capture other relevant dimensions: total costs and budget impact. The overall cost related to PLST due to the relative low unit cost and the low prevalence of patients in need of these treatments, represents a negligible part of the total health care budget. Hence, the emphasis on costs, in this circumstance, is misleading, especially considering that the current health care systems in the developed countries are characterized by wastes and inefficiencies that unduly increase costs. In addition, PLST provide a high return in terms of new knowledge, giving valuable insight on the clinical management of other severe health conditions. Long term therapies can also be considered a highly effective learning environment for health professionals. Finally, prolonged life therapies and treatments can also be considered an environment for experimenting "creative" solutions and approaches.