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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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“This is of concern to all the major stakeholders because it could impact the quality of cancer care and bring undue financial hardship to the patient [41, 42, 56].”
BackgroundMethodAffordable cancer care: pipedream or achievable reality?
Collingridge, D., & Sullivan, R. J. (2014) · The Lancet Oncology · doi:10.1016/s1470-2045(14)70062-2 · Cited by 16
Self-citationThe opportunity cost of cancer care: a statement from NICE
Rawlins, M. D., & Chalkidou, K. (2011) · The Lancet Oncology · doi:10.1016/s1470-2045(11)70218-2 · Cited by 16
Ludwig, W.-D. (2012) · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen · doi:10.1016/j.zefq.2011.12.001 · Cited by 16
Li, X., Wang, L., Wang, J., Han, X., Xia, B., Wu, S., & Hu, W. (2017) · Medical dosimetry · doi:10.1016/j.meddos.2017.06.004 · Cited by 16
Nivolumab Is a Cost-Effective Second-Line Treatment for Metastatic Renal-Cell Carcinoma
Giuliani, J., & Bonetti, A. V. (2018) · Clinical Genitourinary Cancer · doi:10.1016/j.clgc.2018.02.006 · Cited by 16
AIRO Young and AIRO Prostate cancer Working Group, Bari, B. D., Alongi, F., Franco, P., Ciammella, P., Chekrine, T., Livi, L., Jereczek‐Fossa, B. A., & Filippi, A. R. (2013) · La radiologia medica · doi:10.1007/s11547-013-0925-z · Cited by 16
“Una possibile soluzione potrebbe essere un vero approccio multidisciplinare in un contesto di stretta collaborazione tra chirurghi e radio-oncologi, al fine di fornire più trattamenti evidence-based, per evitare over-treatment con conseguente aumento dei costi [16].”
BackgroundChallenges related to palliative care
Kaasa, S., Payne, S. A., & Sjøgren, P. (2011) · The Lancet Oncology · doi:10.1016/s1470-2045(11)70226-1 · Cited by 16
Nursing care dependence in the experiences of advanced cancer inpatients
Piredda, M., Bartiromo, C., Capuzzo, M. T., Matarese, M., & Marinis, M. G. D. (2015) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2015.07.002 · Cited by 16
“This implies that the length of cancer trajectory, the number of comorbidities and disabilities in cancer patients will probably increase in the near future (Sullivan et al., 2011).”
BackgroundDoes comparative effectiveness research promote rationing of cancer care?
Peppercorn, J. M., Zafar, S. Y., Houck, K. L., Ubel, P. A., & Meropol, N. J. (2014) · The Lancet Oncology · doi:10.1016/s1470-2045(13)70597-7 · Cited by 15
Self-citationAbraha, I., Giovannini, G., Serraino, D., Fusco, M., & Montedori, A. (2016) · BMJ Open · doi:10.1136/bmjopen-2015-010409 · Cited by 15
“INTRODUCTION The burden of cancer is increasingly growing among populations and is associated with major economic expenditure, especially in developed countries.(1) While breast cancer is the most common cancer and the leading”
BackgroundQin, S., Yi, L., Li, S., Tan, C., Zeng, X., Wang, L., Ye, P., & Wan, X. (2021) · Advances in Therapy · doi:10.1007/s12325-021-01785-9 · Cited by 15
Yang, Y., Xia, Y., Su, C., Chen, J., Long, E., Zhang, H., Gan, Y., Yan, F., & Chen, Y. (2022) · Journal of Cancer Research and Clinical Oncology · doi:10.1007/s00432-022-04258-w · Cited by 15
Economic Impact Analysis of Cancer in the Health System of Brazil: Model Based in Public Database
Siqueira, A. D. S. E., Gonçalves, J. G., de Mendonça, P. E. X., Merhy, E. E., & Land, M. G. P. (2017) · Health Science Journal · doi:10.21767/1791-809x.1000514 · Cited by 15
Agrawal, S. G., Vamadevan, P., Mazibuko, N., Bannister, R., Swery, R., Wilson, S., & Edwards, S. (2019) · Frontiers in Pharmacology · doi:10.3389/fphar.2019.00681 · Cited by 15
“The economic and health burden of cancer are increasing, due in part to the rising incidence of many cancers, improving and earlier diagnosis, a growing and aging population, and the huge costs of new cancer treatments (Sullivan et al., 2011; Savage and Mahmoud, 2015; Fitzmaurice et al., 2018).”
BackgroundRetractedValentini, V., Dinapoli, N., & Damiani, A. (2013) · Future Oncology · doi:10.2217/fon.12.197 · Cited by 15
Matsuo, K., Nomura, H., Uchiyama, M., Miyazaki, M., & Imakyure, O. (2020) · BMC Health Services Research · doi:10.1186/s12913-020-05822-1 · Cited by 14
Economic evaluation of bevacizumab in the treatment of non-small cell lung cancer (NSCLC)
Shih, Y. T., & Chien (2012) · ClinicoEconomics and Outcomes Research · doi:10.2147/ceor.s27770 · Cited by 14
“Delivering affordable cancer care is a growing concern globally, as is highlighted in a recent paper.(1) Non-small”
BackgroundGigli, A., Warren, J. L., Yabroff, K. R., Francisci, S., Stedman, M. R., Guzzinati, S., Giusti, F., Miccinesi, G., Crocetti, E., Angiolini, C., et al. (2013) · JNCI Monographs · doi:10.1093/jncimonographs/lgt006 · Cited by 14
Lawler, M., & Sullivan, R. J. (2015) · Public Health Genomics · doi:10.1159/000441555 · Cited by 14
Self-citationLustberg, T., Bailey, M., Thwaites, D., Miller, A., Carolan, M., Holloway, L. C., Velazquez, E. R., Hoebers, F. J. P., & Dekker, A. L. A. J. (2016) · Oncotarget · doi:10.18632/oncotarget.8755 · Cited by 14
“Clinical Decision Support Systems (DSS) are a way to support the choice between the increasing number of radiotherapy techniques and technology options [13-15] both in terms of clinical benefit in the individual patient and in assigning resources to patient groups that benefit most from the new technology to address t…”
BackgroundChoosing wisely in oncology: necessity and obstacles
Saletti, P., Sanna, P., Gabutti, L., & Ghielmini, M. E. G. (2018) · ESMO Open · doi:10.1136/esmoopen-2018-000382 · Cited by 14
“Costs are influenced by many factors, including the rapid expansion and accelerated renewal of technologies consequent to the growing research results, the lack of good health economy studies, the access disparity to technologies for the patients, the limits of the regulatory systems and, last but not least, the overu…”
BackgroundCarrera, P. M., & Zafar, S. Y. (2018) · Springer eBooks · doi:10.1007/978-3-319-90990-5_9 · Cited by 14
Rationing Cancer Care: A Survey Among the Members of the German Society of Hematology and Oncology
Krause, S. W., Schildmann, J., Lotze, C., & Winkler, E. C. (2013) · Journal of the National Comprehensive Cancer Network · doi:10.6004/jnccn.2013.0085 · Cited by 14
“Q7: Low cost/benefit ratio 88/81 Supportive care Bevacizumab Other antibodies Erlotinib* Other “new drugs” Cytostatic drugs 5 (6) 24 (30) 8 (10) 27 (33) 8 (10) 9 (11)”
Kim, S. J., Han, K., Park, E., Park, S., & Kim, T. H. (2014) · Asian Pacific Journal of Cancer Prevention · doi:10.7314/apjcp.2014.15.13.5265 · Cited by 14
“Simultaneously there are rising questions of cost-benefit for the proven interventions by individual or society level (Sullivan et al., 2011).”
BackgroundLorgelly, P., Doble, B., Knott, R., & The Cancer 2015 Investigators (2016) · PharmacoEconomics (Auckland) · doi:10.1007/s40273-015-0343-2 · Cited by 13
“In a recent Lancet Oncology Commission paper, Sullivan and colleagues [2] discuss many of the challenges of delivering affordable cancer care in the future, highlight the drivers of health costs and provide a number of potential remedies so countries can continue to deliver high-quality care to all cancer patients in…”
BackgroundThe need for community pharmacists in oncology outpatient care: a systematic review
Thoma, J., Zelkó, R., & Hankó, B. (2016) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-016-0297-2 · Cited by 14
“2 million Europeans are diagnosed with cancer, a figure that is expected to rise as the population ages [2].”
Background
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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