Delivering affordable cancer care in high-income countries
Abstract
The burden of cancer is growing, and the disease is becoming a major economic expenditure for all developed countries. In 2008, the worldwide cost of cancer due to premature death and disability (not including direct medical costs) was estimated to be US$895 billion. This is not simply due to an increase in absolute numbers, but also the rate of increase of expenditure on cancer. What are the drivers and solutions to the so-called cancer-cost curve in developed countries? How are we going to afford to deliver high quality and equitable care? Here, expert opinion from health-care professionals, policy makers, and cancer survivors has been gathered to address the barriers and solutions to delivering affordable cancer care. Although many of the drivers and themes are specific to a particular field-eg, the huge development costs for cancer medicines-there is strong concordance running through each contribution. Several drivers of cost, such as over-use, rapid expansion, and shortening life cycles of cancer technologies (such as medicines and imaging modalities), and the lack of suitable clinical research and integrated health economic studies, have converged with more defensive medical practice, a less informed regulatory system, a lack of evidence-based sociopolitical debate, and a declining degree of fairness for all patients with cancer. Urgent solutions range from re-engineering of the macroeconomic basis of cancer costs (eg, value-based approaches to bend the cost curve and allow cost-saving technologies), greater education of policy makers, and an informed and transparent regulatory system. A radical shift in cancer policy is also required. Political toleration of unfairness in access to affordable cancer treatment is unacceptable. The cancer profession and industry should take responsibility and not accept a substandard evidence base and an ethos of very small benefit at whatever cost; rather, we need delivery of fair prices and real value from new technologies.
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Indirect economic costs from premature death and lost productivity due to the growing cancer burden have been estimated at US$1.16 trillion per year, approaching 2% of global GDP.
“The indirect economic costs associated with premature death and lost productivity from the growing cancer burden have been estimated at US$1.16 trillion a year,3 or approaching 2% of global GDP.103”
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Self-citationCancer survival: global surveillance will stimulate health policy and improve equity
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Self-citationAutomation in intensity modulated radiotherapy treatment planning—a review of recent innovations
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Self-citationApplying What We Know to Accelerate Cancer Prevention
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“Happily, the millions of Americans living after or with cancer testify to the many advances, but the ever-growing burden of cancer and other chronic illnesses is predicted to outstrip the national capacity to detect, treat, and follow up the millions affected (2).”
BackgroundIyengar, S., Tay-Teo, K., Vogler, S., Beyer, P., Wiktor, S. Z., de Joncheere, K., & Hill, S. R. (2016) · PLoS Medicine · doi:10.1371/journal.pmed.1002032 · Cited by 255 · see citing works
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Self-citationInterventions for promoting habitual exercise in people living with and beyond cancer
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Self-citationHow do people judge risks: Availability heuristic, affect heuristic, or both?
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“Finally, cost of cancer treatment is causing global concern (20), and calcium electroporation is both simple and inexpensive and is likely to be of potential benefit in the treatment of local tumors regardless of histology.”
BackgroundFollow-up care of cancer survivors: challenges and solutions
Jacobs, L. A., & Shulman, L. N. (2016) · The Lancet Oncology · doi:10.1016/s1470-2045(16)30386-2 · Cited by 223 · see citing works
The Out-of-Pocket Cost Burden of Cancer Care—A Systematic Literature Review
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“Although healthcare insurance coverage differs across jurisdictions, the literature suggests that medical debt is not just a problem in low‐ and middle‐income countries (LMICs); it also extends to insured individuals in high‐in‐ come countries (HICs) [10].”
BackgroundEffective Coverage: A Metric for Monitoring Universal Health Coverage
Ng, M., Fullman, N., Dieleman, J. L., Flaxman, A. D., Murray, C. J. L., & Lim, S. S. (2014) · PLoS Medicine · doi:10.1371/journal.pmed.1001730 · Cited by 214 · see citing works
“For higher-income countries, UHC is likely to primarily focus on improved access to treatment of and preventive services for non-communicable diseases [14].”
BackgroundReview and Uses of Stereotactic Body Radiation Therapy for Oligometastases
Alongi, F., Arcangeli, S., Filippi, A. R., Ricardi, U., & Scorsetti, M. (2012) · The Oncologist · doi:10.1634/theoncologist.2012-0092 · Cited by 209 · see citing works
“tially result in substantial direct and indirect cost savings [64].”
BackgroundEhsan, A. N., Wu, C. A., Minasian, A., Singh, T., Bass, M., Pace, L., Ibbotson, G. C., Bempong-Ahun, N., Pusic, A., Scott, J. W., et al. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.55388 · Cited by 183 · see citing works
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Analysis of Global Radiotherapy Needs and Costs by Geographic Region and Income Level
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“4% (UK in 2007) to 18% (USA in 2009) of a country’s gross domestic product [32].”
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Distributed learning on 20 000+ lung cancer patients – The Personal Health Train
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“However, data sharing is hampered by administrative, political, ethical, and technical barriers [1].”
BackgroundThe State of the Art in the Development of Biosimilars
McCamish, M., & Woollett, G. (2012) · Clinical Pharmacology & Therapeutics · doi:10.1038/clpt.2011.343 · Cited by 160 · see citing works
Quantifying the burden of informal caregiving for patients with cancer in Europe
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“…fi nancial ability of countries to deliver care, especially for cancer which in the US is estimated to cost $174 billion in 2020 and to exceed $245 billion by 2030, [37,38] was a concern for even high-income countries before the global economic slowdown brought on by the COVID-19 pandemic [25,39].”
Decision support systems for personalized and participative radiation oncology
Lambin, P., Zindler, J. D., Vanneste, B. G. L., Voorde, L. V. D., Eekers, D. B. P., Compter, I., Panth, K. M., Peerlings, J., Larue, R. T. H. M., Deist, T. M., et al. (2016) · Advanced Drug Delivery Reviews · doi:10.1016/j.addr.2016.01.006 · Cited by 154 · see citing works
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A critical review of recent developments in radiotherapy for non-small cell lung cancer
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“3DCRT therefore remains an important treatment option, especially as access to radiotherapy is limited in many countries, and escalating costs are of concern [95, 96].”
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“lined in leading journals [23, 24].”
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“[3] As such, breast cancer puts a heavy burden on patients and their families, as well as healthcare systems across the world.”
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“Since medical innovation does not follow Moore’s law, the cost of cancer treatment is also skyrocketing (Sullivan et al., 2011).”
BackgroundKis, B., Ifrim, F. C., Buda, V. O., Avram, Ș., Pavel, I. Z., Antal, D., Păunescu, V., Dehelean, C. A., Ardelean, F., Diaconeasa, Z. M., et al. (2019) · International Journal of Molecular Sciences · doi:10.3390/ijms20235905 · Cited by 148 · see citing works
“Breast cancer is the primary cause of death among women and is the second most common cancer overall [95].”
BackgroundSupportive Care: An Indispensable Component of Modern Oncology
Berman, R. B., Davies, A. N., Cooksley, T., Gralla, R. J., Carter, L., Darlington, E., Scotté, F., & Higham, C. E. (2020) · Clinical Oncology · doi:10.1016/j.clon.2020.07.020 · Cited by 136 · see citing works
“The disease is becoming a major economic expenditure for all developed countries [10].”
BackgroundA Comprehensive Review of Calcium Electroporation—A Novel Cancer Treatment Modality
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“There is therefore a great need of new cancer treatments to lower the cost of treatments in high-income countries [124] as well as in low- and middle-income countries [123,125,126].”
BackgroundFAPI PET/CT: Will It End the Hegemony of 18F-FDG in Oncology?
Hicks, R. J., Roselt, P. D., Kallur, K. G., Tothill, R. W., & Mileshkin, L. (2020) · Journal of Nuclear Medicine · doi:10.2967/jnumed.120.256271 · Cited by 128 · see citing works
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BackgroundSelf-citationThe role of the GP in follow-up cancer care: a systematic literature review
Meiklejohn, J. A., Mimery, A., Martin, J. H., Bailie, R. S., Garvey, G., Walpole, E. T., Adams, J., Williamson, D. S., & Valery, P. C. (2016) · Journal of Cancer Survivorship · doi:10.1007/s11764-016-0545-4 · Cited by 123 · see citing works
“These rising global health care costs of cancer demand renewed attention to health system structures and processes [8].”
Patient Experience and Attitudes Toward Addressing the Cost of Breast Cancer Care
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Self-citationHow might healthcare systems influence speed of cancer diagnosis: A narrative review
Brown, S. R., Castelli, M., Hunter, D. J., Erskine, J., Vedsted, P., Foot, C., & Rubin, G. P. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.06.030 · Cited by 115 · see citing works
“Finally, the literature is inconsistent regarding the relationship between cancer outcomes and health expenditure: some studies show that higher healthcare spending is not always associated with better cancer outcome (Kanavos and Schurer, 2010; Sullivan et al., 2011; Aberg et al., 2012).”
BackgroundCancer drug development: The missing links
Kunnumakkara, A. B., Bordoloi, D., Sailo, B. L., Roy, N. K., Thakur, K. K., Banik, K., Shakibaei, M., Gupta, S. C., & Aggarwal, B. B. (2019) · Experimental Biology and Medicine · doi:10.1177/1535370219839163 · Cited by 114 · see citing works
Provision and use of radiotherapy in Europe
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“Moreover, healthcare systems need to be made sustainable, also in high-income regions such as Europe: the growing annual increase in cancer costs is one of the main risks to the future financing of health care (Sullivan et al., 2011).”
BackgroundChanging global policy to deliver safe, equitable and affordable care for women's cancers
Ginsburg, O., Badwe, R., Boyle, P., Derricks, G., Dare, A., Evans, T., Eniu, A., Jimenez, J., Kutluk, T., Lopes, G., et al. (2017) · The Lancet · doi:10.1016/s0140-6736(16)31393-9 · Cited by 102 · see citing works
Self-citationPersonalizing health care: feasibility and future implications
Godman, B., Finlayson, A. E. T., Cheema, P. K., Zebedin-Brandl, E. M., Gutiérrez‐Ibarluzea, I., Jones, J., Malmström, R. E., Asola, E., Baumgärtel, C., Bennie, M., et al. (2013) · BMC Medicine · doi:10.1186/1741-7015-11-179 · Cited by 103 · see citing works
“This is illustrated by complex tests for patients with breast cancer costing approximately US$3,900 per test in the US, although these have been shown to reduce overall treatment costs [35,92,249].”
BackgroundInfluentialHuang, H., Shi, J., Guo, L.-W., Bai, Y., Liao, X., Liu, G., Mao, A., Ren, J., Sun, X., Zhu, X.-Y., et al. (2017) · 癌症：英文版 · doi:10.1186/s40880-017-0209-4 · Cited by 103 · see citing works
“Significant advances have been made worldwide in improving CRC patient survival, which are bound to increase the financial burden at the aggregate level, especially in the context of high prevalence and rapid population growth [1, 3].”
BackgroundImplicating anaesthesia and the perioperative period in cancer recurrence and metastasis
Dubowitz, J. A., Sloan, E. K., & Riedel, B. (2017) · Clinical & Experimental Metastasis · doi:10.1007/s10585-017-9862-x · Cited by 103 · see citing works
Higginson, I. J., Gomes, B., Calanzani, N., Gao, W., Bausewein, C., Daveson, B. A., Deliëns, L., Ferreira, P. L., Toscani, F., Gysels, M., et al. (2013) · Palliative Medicine · doi:10.1177/0269216313488989 · Cited by 99 · see citing works
Actual costs of cancer drugs in 15 European countries
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Arsenijevic, J., Pavlova, M., Rechel, B., & Groot, W. N. J. (2016) · PLoS ONE · doi:10.1371/journal.pone.0157765 · Cited by 97 · see citing works
“Finally, premature death is more common among cancer patients than among patients with other chronic diseases [46, 47].”
BackgroundProtons in Head-and-Neck Cancer: Bridging the Gap of Evidence
Ramaekers, B. L. T., Grutters, J. P. C., Pijls-Johannesma, M. C. G., Lambin, P., Joore, M. A., & Langendijk, J. A. (2012) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/j.ijrobp.2012.11.006 · Cited by 95 · see citing works
Health Economic Controversy and Cost-Effectiveness of Proton Therapy
Lievens, Y. N., & Pijls-Johannesma, M. C. G. (2013) · Seminars in Radiation Oncology · doi:10.1016/j.semradonc.2012.11.005 · Cited by 94 · see citing works
Malmström, R. E., Godman, B., Diogène, E., Baumgärtel, C., Bennie, M., Bishop, I., Brzezinska, A., Bucsics, A., Campbell, S., Ferrario, A., et al. (2013) · Frontiers in Pharmacology · doi:10.3389/fphar.2013.00039 · Cited by 90 · see citing works
“…drugs in development (EvaluatePharma, 2012; Godman, 2013) including new cancer drugs (Nagle et al., 2008; National Cancer Institute, 2010; Sullivan et al., 2011; Mullard, 2012), which are now costing up to US$10,000–25,000 (€7580–18,960) per patient per month (Selyukh, 2011; Yukhananov,…”
Backgroundvan Loon, J., Grutters, J. P. C., & Macbeth, F. R. (2012) · The Lancet Oncology · doi:10.1016/s1470-2045(11)70379-5 · Cited by 91 · see citing works
Zerka, F., Urovi, V., Vaidyanathan, A., Barakat, S., Leijenaar, R. T. H., Walsh, S., Gabrani-Juma, H., Miraglio, B., Woodruff, H. C., Dumontier, M., et al. (2020) · IEEE Access · doi:10.1109/access.2020.3029445 · Cited by 89 · see citing works
“…data in healthcare is through multicentric studies, however, recent legal and ethical considerations (e.g., General Data Protection Regulation (GDPR) and Health Insurance Portability and Accountability Act (HIPAA)) have now made multicentric studies with centralized databases problematic [10].”
BackgroundAppraising iniparib, the PARP inhibitor that never was—what must we learn?
Mateo, J., Ong, M., Tan, D. S. P., Gonzalez, M. A., & de Bono, J. S. (2013) · Nature Reviews Clinical Oncology · doi:10.1038/nrclinonc.2013.177 · Cited by 96 · see citing works
Ashley, L., Jones, H., Thomas, J., Newsham, A., Downing, A., Morris, E. J. A., Brown, J. M., Velikova, G., Forman, D., & Wright, P. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2764 · Cited by 86 · see citing works
“The escalating costs of cancer care in times of fiscal tightness augur challenging decisions for service planners [4].”
Delivering maximum clinical benefit at an affordable price: engaging stakeholders in cancer care
Kelly, R. J., & Smith, T. J. (2014) · The Lancet Oncology · doi:10.1016/s1470-2045(13)70578-3 · Cited by 86 · see citing works
Modelling the benefits of early diagnosis of pancreatic cancer using a biomarker signature
Ghatnekar, O., Andersson, R., Svensson, M., Persson, U., Ringdahl, U., Zeilon, P., & Borrebaeck, C. A. K. (2013) · International Journal of Cancer · doi:10.1002/ijc.28256 · Cited by 85 · see citing works
“When the timing of treatment is important for achieving successful results, the costs of cancer care increases due to a higher risk of over-utilisation of diagnostic procedures or treatments.(26,27) Even if a diagnostic test in itself adds to these costs, the tests can create additional value in a socioeconomic perspe…”
BackgroundDrugs, cancer and end-of-life care: A case study of pharmaceuticalization?
Davis, C. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.12.007 · Cited by 84 · see citing works
Purdie, T. G., Dinniwell, R. E., Fyles, A., & Sharpe, M. B. (2014) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/j.ijrobp.2014.06.056 · Cited by 84 · see citing works
Cancer research in India: national priorities, global results
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Self-citationTherapeutic application of monoclonal antibodies in cancer: advances and challenges
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Update on Immune Checkpoint Inhibitors in Lung Cancer
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A Promising Future of Ferroptosis in Tumor Therapy
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“value-based approaches to bend the cost curve and allow cost saving technologies), educating policy makers, introducing transparent and equitable regulatory systems, and adopting validated outcomes in both clinical trials and processes of drug approval [1,2].”
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“Many treatments introduced in clinical practice are molecularly targeted agents [4], whose costs vary between an average of approximately $5,000 (€3,700) to more than $10,000 (€7,400) per month [5], most often exceeding $25,000 (€18,500) per year.”
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“The report by the Lancet ncology Commission on the affordability of cancer in high-income ountries has conceptualised the debate and we have set out in this ection to review the changes and ethos of EU-28 countries towards ancer economics [6].”
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“Consequently, the societal burden of CRC is significant and is likely to increase over time (8,9).”
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“5 billion in 2010, with an unsustainable rate of increase [2].”
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“As previously mentioned, studies show disparities for Hispanics in the US for stage at diagnoses,(5) screening rates,(32,33) access to health care,(31) differences in treatment,(36) and cost barriers.(35) However, mortality data is not stage specific, and our data sources did not contain specific information on these…”
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Stereotactic Body Radiotherapy for Prostate Cancer
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“Another attraction of SBRT in this setting is cost, given that a key healthcare priority in the current environment is to deliver affordable care [17].”
Background
- Authors
- Sullivan, R., Peppercorn, J., Sikora, K., Zalcberg, J., Meropol, N. J., Amir, E., Khayat, D., Boyle, P., Autier, P., Tannock, I. F., Fojo, T., Siderov, J., Williamson, S., Camporesi, S., McVie, J. G., Purushotham, A. D., Naredi, P., Eggermont, A., Brennan, M. F., Steinberg, M. L., De Ridder, M., McCloskey, S. A., Verellen, D., Roberts, T., Storme, G., Hicks, R. J., Ell, P. J., Hirsch, B. R., Carbone, D. P., Schulman, K. A., Catchpole, P., Taylor, D., Geissler, J., Brinker, N. G., Meltzer, D., Kerr, D., & Aapro, M.
- Affiliations
- Guy's Hospital (GB)
- Duke Medical Center (US)
- The University of Melbourne (AU)
- University Hospitals Seidman Cancer Center (US)
- University of Toronto (CA)
- Pitié-Salpêtrière Hospital (FR)
- International Prevention Research Institute (FR)
- National Cancer Institute (US)
- Austin Hospital (AU)
- Northumbria Healthcare NHS Foundation Trust (GB)
- King's College London (GB)
- European Institute of Oncology (IT)
- Umeå University (SE)
- Institut Gustave Roussy (FR)
- Memorial Sloan Kettering Cancer Center (US)
- University of California, Los Angeles (US)
- Vrije Universiteit Brussel (BE)
- Peter MacCallum Cancer Centre (AU)
- University College London (GB)
- Duke University (US)
- Vanderbilt University Medical Center (US)
- Association of the British Pharmaceutical Industry (GB)
- University of London (GB)
- Susan G. Komen Breast Cancer Foundation (US)
- University of Chicago (US)
- University of Oxford (GB)
- Clinique de Genolier (CH)
- Corresponding author
- Sullivan, Richard
- ORCID
- Sullivan, Richard
- Peppercorn, Jeffrey
- Sikora, Karol
- Zalcberg, John
- Meropol, Neal J
- Amir, Eitan
- Boyle, Peter
- Autier, Philippe
- Tannock, Ian F
- Fojo, Tito
- Siderov, Jim
- Williamson, Steve
- Camporesi, Silvia
- Purushotham, Arnie D
- Naredi, Peter
- Eggermont, Alexander
- Brennan, Murray F
- Steinberg, Michael L
- McCloskey, Susan A
- Verellen, Dirk
- Storme, Guy
- Hicks, Rodney J
- Schulman, Kevin A
- Taylor, David
- Geissler, Jan
- Meltzer, David
- Kerr, David
- Aapro, Matti
- Venue
- The Lancet Oncology
- Publisher
- Elsevier BV
- Published
- 2011-09
- Volume
- 12
- Issue
- 10
- Pages
- 933-980
- ISSN
- 1470-2045 (ISSN-L)
- OpenAlex
- W2111285159
- Cited by
- 718
- References
- 279
- Citations by year
- 2026: 21 · 2025: 24 · 2024: 34 · 2023: 16 · 2022: 33 · 2021: 43 · 2020: 40 · 2019: 32 · 2018: 60 · 2017: 45 · 2016: 56 · 2015: 67 · 2014: 75 · 2013: 81 · 2012: 76
- FWCI
- 199.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet Oncology (publishedVersion)
- PubMed (publishedVersion)
- Strathprints: The University of Strathclyde institutional repository (University of Strathclyde) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- VUBIR (Vrije Universiteit Brussel) (submittedVersion)
- Funders
- Conquer Cancer Foundation
- King's College Hospital NHS Foundation Trust
- National Institute for Health and Care Research
- Department of Health and Social Care
- King's College London
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advances in Oncology and Radiotherapy
- Keywords
- cancer costs, high-income countries, value-based pricing, access to cancer treatment, health equity, regulatory regimes, health policy, overuse of health care
- MeSH terms
- Australia, Cost-Benefit Analysis, Europe, Health Expenditures, Health Policy, Health Services Accessibility, Health Services Misuse, Health Services Research, Humans, Insurance, Health, Neoplasms, Socioeconomic Factors, United States, Cost Savings, Health Care Costs, Health Care Reform, Models, Economic, Delivery of Health Care, Integrated, Healthcare Disparities
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