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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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Garattini, L., van de Vooren, K., & Zaniboni, A. (2012) · Health Policy · doi:10.1016/j.healthpol.2012.08.017 · Cited by 8
Nekhlyudov, L., & Wenger, N. S. (2014) · Journal of General Internal Medicine · doi:10.1007/s11606-014-2931-9 · Cited by 8
“Further, the costs of cancer care continue to increase, outpacing the rise in the costs of care for non-cancer conditions,(3) and may begin to account for a greater share of total health care spending.(5) These factors contribute to a potential crisis in both access and costs, and characterize a cancer care system tha…”
BackgroundGeographic Variation in Postoperative Imaging for Low-Risk Breast Cancer
Franc, B. L., Copeland, T. P., Thombley, R. L., Park, M., Marafino, B. J., Dean, M. L., Boscardin, W. J., Rugo, H. S., Seidenwurm, D. J., Sharma, B., et al. (2018) · Journal of the National Comprehensive Cancer Network · doi:10.6004/jnccn.2018.7024 · Cited by 8
Intensive care of haematological patients.
Magid, T., Haase, N., Andersen, J. S., Nielsen, O. J., & Bonde, J. (2012) · PubMed · Cited by 8
Equity of access to treatment on the Cancer Drugs Fund: A missed opportunity for cancer research?
Chamberlain, C., Collin, S. M., Hounsome, L. S., Owen‐Smith, A., Donovan, J., & Hollingworth, W. (2015) · Journal of Cancer Policy · doi:10.1016/j.jcpo.2015.06.003 · Cited by 9
“Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms.html Take down policy Explore Bristol Research is a digital archive and the intention is that deposited content should not be removed.”
MethodHaywood, P., de Raad, J., Gool, K. V., Haas, M. R., Gallego, G., Pearson, S., Faedo, M., & Ward, R. L. (2012) · PharmacoEconomics · doi:10.2165/11597280-000000000-00000 · Cited by 8
“Treatment for cancer is costly and will place an increasing burden on healthcare resources costs.([1]) In recent years, many new chemotherapeutic agents have become available whose use, in general, results in small incremental gains in survival at considerable additional costs.”
BackgroundRethinking end-points for bone-targeted therapy in advanced cancer
García, S. G., Clemons, M. J., & Amir, E. (2016) · European Journal of Cancer · doi:10.1016/j.ejca.2016.05.014 · Cited by 8
“The delivery of affordable, high quality, evidencebased healthcare is a major issue affecting all countries including those with high income [25].”
BackgroundSelf-citationCancer control in Latin America and the Caribbean: a bold ambition?
Collingridge, D. (2013) · The Lancet Oncology · doi:10.1016/s1470-2045(13)70111-6 · Cited by 8
Balogh, E. P., Bach, P. B., Eisenberg, P. D., Ganz, P. A., Green, R. J., Gruman, J. C., Nass, S. J., Newcomer, L. N., Ramsey, S. D., Schottinger, J. E., et al. (2013) · Journal of Oncology Practice · doi:10.1200/jop.2013.001123 · Cited by 7
“develop a treatment plan, and (6) ensure that all members of the”
BackgroundLiao, W., Huang, J., Wu, Q., Wen, F., Zhang, N., Zhou, K., Bai, L., & Li, Q. (2019) · Breast Cancer · doi:10.1007/s12282-019-01034-6 · Cited by 8
Economic Impact of Imaging Overutilization in Cancer Care
Manohar, P. M., Ramsey, S. D., & Shankaran, V. (2020) · Journal of the American College of Radiology · doi:10.1016/j.jacr.2019.07.030 · Cited by 7
Kalouguina, V., & Wagner, J. (2020) · Journal of risk and financial management · doi:10.3390/jrfm13110283 · Cited by 8
“Trosman et al. (2010) in their article understand that the variation in coverage among payers depends on the type of evidence used and the perception of this evidence.”
BackgroundSifaki-Pistolla, D. I., Chatzea, V., Frouzi, E., Mechili, E. A., Pistolla, G. D., Nikiforidis, G. C., Georgoulias, V., Lionis, C. D., & Tzanakis, N. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191912765 · Cited by 7
“Currently, the nature of cancer control is changing, with an increasing emphasis on risk factor controlling and prevention, early diagnosis, as well as patient experience during and after treatment [5].”
BackgroundValue-based procurement of prostheses for total knee replacement
Messori, A., & Trippoli, S. (2018) · Orthopedic Reviews · doi:10.4081/or.2017.7488 · Cited by 7
Overuse in cancer care: do European studies provide information useful to support policies?
Grilli, R. G., & Chiesa, V. (2018) · Health Research Policy and Systems · doi:10.1186/s12961-018-0287-z · Cited by 7
“Overuse of diagnostic and therapeutic procedures/ interventions has also been identified as an issue in cancer care [6, 52].”
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“However, it is apparent that modern oncology drugs are relatively expensive and that managing the cost of evolving treatment protocols is challenging the finances in many types of healthcare provision.(9,10) A less wellstudied impact of the rapid evolution in cancer care is the impact of increasing number of patient t…”
BackgroundDealing with death in cancer care: should the oncologist be an amicus mortis?
Carrieri, D., Peccatori, F. A., Grassi, L. G., & Boniolo, G. (2019) · Supportive Care in Cancer · doi:10.1007/s00520-019-05137-w · Cited by 8
“overuse of care by patients and HCPs in high-income countries [1].”
BackgroundKostenexplosion in der medikamentösen Therapie onkologischer Erkrankungen
Ludwig, W.-D., & Schildmann, J. (2015) · Der Onkologe · doi:10.1007/s00761-015-2958-5 · Cited by 7
Informatics in Radiation Oncology
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“Several centers have taken up the legal, ethical, and administrative challenges [ 62 ] of sharing data and initiated projects aimed at making clinical data machine readable and exchangeable.”
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Schöne-Seifert, B., Friedrich, D. R., & Diederich, A. (2012) · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen · doi:10.1016/j.zefq.2012.06.008 · Cited by 6
Personalized Medicine: Does the Molecular Suit Fit?
Liu, E. T., & Johnston, P. G. (2013) · The Oncologist · doi:10.1634/theoncologist.2013-0191 · Cited by 6
A Comparison of Incremental Costs of Breast Cancer Clinical Trials to Standard of Care
Eliasziw, B. J. M. (2014) · Journal of Clinical Trials · doi:10.4172/2167-0870.1000216 · Cited by 6
“These findings are similar to those seen in a cohort of prostate cancer patients we previously examined [18], and so the aggregate of these findings further question the idea that clinical trials are a burden on a public-payer health-care system.”
ResultAre U.S. trends a barometer of future cancer transitions in emerging economies?
Vaccarella, S., & Bray, F. (2019) · International Journal of Cancer · doi:10.1002/ijc.32485 · Cited by 6
“Even the most affluent countries will struggle to ensure sufficient resources to confront the future cancer patient landscape.(17) How then can we fast-track a more favorable cancer trajectory? It is evident that cancer prevention, if prioritized, could lead to a drastic reduction in the expected number of cancer diag…”
BackgroundFactors associated with high-cost hospitalizations in elderly ovarian cancer patients
Manrriquez, E. N., Mandelbaum, A. D., Aguayo, E., Zakhour, M., Karlan, B. Y., Benharash, P., & Cohen, J. G. (2020) · Gynecologic Oncology · doi:10.1016/j.ygyno.2020.09.026 · Cited by 6
Anesthetic care influences long-term outcomes: What is the evidence?
RAMIREZ, M., & Cata, J. P. (2021) · Best practice & research. Clinical anaesthesiology · doi:10.1016/j.bpa.2021.01.004 · Cited by 6
Sullivan, R. J., Lewison, G., Torode, J., Kingham, T. P., Brennan, M. F., Shulman, L. N., Lawler, M., Aggarwal, A. K., & Gralow, J. R. (2022) · The Lancet Oncology · doi:10.1016/s1470-2045(22)00079-1 · Cited by 6
Self-citationHealth Economics and Cancer Care
Yeoh, K. K., & Gray, A. M. (2022) · Clinical Oncology · doi:10.1016/j.clon.2022.05.014 · Cited by 6
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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