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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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“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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“increasingly prominent [9–11], and must be considered in all treatment approaches.”
BackgroundLopes, G. D. L., Jr., Glück, S., Avancha, K. K. V. R., & Montero, A. J. (2012) · Breast Cancer Research and Treatment · doi:10.1007/s10549-012-2326-8 · Cited by 31
“2,000 mg/m2 day 1–14 or 3,500 mg, i.e. 7,500 mg tablets b Calculated based on sum of multiplying total cost per cycle by % patients receiving that particular agent: vinorelbine ($103.82 9 0 0.25 = $25.96), gemcitabine ($1085.93 9 0.19 = $206.33), and capecitabine ($2,533.5 9 0.18 = $456.03) c Assuming 70/30 split betw…”
BackgroundInfluentialCost effectiveness after a pancreaticoduodenectomy: bolstering the volume argument
Sutton, J. M., Wilson, G. C., Paquette, I. M., Wima, K., Hanseman, D. J., Quillin, R. C., SUSSMAN, J. S., Edwards, M. J., Ahmad, S. A., Shah, S. A., et al. (2014) · HPB · doi:10.1111/hpb.12309 · Cited by 32
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“As the costs associated with cancer care have increased extensively in the last decade ($895 billion USD in 2008 figures [19] and €126 billion Euros in 2009 figures [11]), it is of paramount importance to contain the current cancer cost expenditure’s extravaganza.”
BackgroundNeumann, P. J., Bliss, S. K., & Chambers, J. D. (2012) · Health Affairs · doi:10.1377/hlthaff.2011.1309 · Cited by 32
Najafzadeh, M., Johnston, K., Peacock, S. J., Connors, J. M., Marra, M. A., Lynd, L. D., & Marra, C. A. (2013) · BMC Health Services Research · doi:10.1186/1472-6963-13-454 · Cited by 32
“Our knowledge about these relative preference weights can offer a value-based framework [11] for evaluating and comparing new genomic tests.”
BackgroundCastlen, J. P., Coté, D. J., Moojen, W. A., Robe, P. A. J. T., Balak, N., Brennum, J., Ammirati, M., Mathiesen, T. I., & Broekman, M. L. D. (2017) · World Neurosurgery · doi:10.1016/j.wneu.2017.03.073 · Cited by 32
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Position statement on ethics, equipoise and research on charged particle radiation therapy
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Access to innovative radiotherapy: how to make it happen from an economic perspective?
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“CED allows provisional access to promising technologies earlier in their life cycle when evidence is still uncertain, by making the coverage decision conditional upon targeted research or the collection of additional population-level evidence [40,46,47].”
BackgroundFighting Fire with Fire: Rekindling the Bevacizumab Debate
Montero, A. J., & Vogel, C. L. (2012) · New England Journal of Medicine · doi:10.1056/nejme1113368 · Cited by 31
Andreyev, J. N., Adams, R., Bornschein, J., Chapman, M., Chuter, D., Darnborough, S., Davies, A., Dignan, F. L., Donnellan, C. F., Fernandes, D., et al. (2025) · Gut · doi:10.1136/gutjnl-2024-333812 · Cited by 31
Health Systems Performance and Cancer Outcomes
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“Due to the dramatically increasing cost and the uncertainty of survival benefits, innovative drugs combined with existing treatment schemes often have lower cost-effective probabilities than standard treatment regimens (14).”
BackgroundBates, N., Callander, E. J., Lindsay, D., & Watt, K. (2018) · Health Economics Review · doi:10.1186/s13561-018-0212-8 · Cited by 30
“These costs are expected to rise with new technologies, new pharmacotherapies, and population changes [20].”
BackgroundPET/MR Imaging: A Critical Appraisal
Weber, W. (2014) · Journal of Nuclear Medicine · doi:10.2967/jnumed.113.129270 · Cited by 29
“In many countries, there are serious concerns about rising health care costs for aging populations (30).”
BackgroundDaveson, B. A., Alonso, J. P., Calanzani, N., Ramsenthaler, C., Gysels, M., Antunes, B., Moens, K., Groeneveld, E. I., Albers, G., Finetti, S., et al. (2013) · European Journal of Public Health · doi:10.1093/eurpub/ckt029 · Cited by 30
Cost profiles of colorectal cancer patients in Italy based on individual patterns of care
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“where duration 1 corresponds to the time interval [0,1), and duration 2 corresponds to the time interval [1,2).”
BackgroundCardoso, F., MacNeill, F. A., Penault-Llorca, F. M., Eniu, A. E., Sardanelli, F., Nordström, E. B., & Poortmans, P. M. (2021) · The Breast · doi:10.1016/j.breast.2020.12.010 · Cited by 29
“Several studies have shown that indirect costs of cancer outweigh the direct costs ([53,54]).”
BackgroundTranslating Regenerative Biomaterials Into Clinical Practice
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Valuing end-of-life care in the United States: the case of new cancer drugs
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“…estimates indicating that 50–75% of drug or biologic therapy used to treat cancer is off-label (Soares, 2005), use is higher in advanced cases when patients are no longer experiencing benefit from standard approved treatments, and increasingly involves expensive therapies (Sullivan et al., 2011).”
BackgroundNHS cancer services and systems—ten pressure points a UK cancer control plan needs to address
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“The availability of biosimilars is expected to reduce cancer drug budgets as biosimilars are generally less expensive than original biologics [2].”
BackgroundInterventions for promoting habitual exercise in people living with and beyond cancer.
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“[2] Even when RCT data provides the best evidence on efficacy, CEA authors are encouraged to utilize the potential of CEAs to overcome limitations of RCT-based guidance.”
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Cost, Coverage, and Comparative Effectiveness Research: The Critical Issues for Oncology
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on behalf of AIRO Young and AIRO Prostate cancer Working Group, Alongi, F., Bari, B. D., Franco, P., Ciammella, P., Chekrine, T., Livi, L., Jereczek‐Fossa, B. A., & Filippi, A. R. (2013) · La radiologia medica · doi:10.1007/s11547-012-0913-8 · Cited by 26
“Una possibile soluzione potrebbe essere un vero approccio multidisciplinare in un contesto di stretta collaborazione tra chirurghi e oncologi radioterapisti, al fine di indicare più trattamenti basati sull’evidenza, per evitare trattamenti superflui ed un aumento dei costi [18].”
Caregivers’ Death-Preparedness States Impact Caregiving Outcomes and Patients’ End-of-Life Care
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Metadata
- 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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