title: Expensive cancer drugs: a comparison between the United States and the United Kingdom.
abstract: BACKGROUND
  This article compares the United Kingdom's and the United States' experiences with expensive cancer drugs to illustrate the challenges posed by new, extremely costly, medical technologies.
  
  
  METHODS
  This article describes British and American coverage, access, and cost-sharing policies with regard to expensive cancer drugs and then compares the costs of eleven such drugs to British patients, American Medicare beneficiaries, and American patients purchasing the drugs in the retail market. Three questions posed by these comparisons are then examined: First, which system is fairer? In which system are cancer patients better off? Assuming that no system can sustainably provide to everyone at least some expensive cancer drugs for some clinical indications, what challenges does each system face in making these difficult determinations?
  
  
  RESULTS
  In both the British and American health care systems, not all patients who might benefit from or desire access to expensive cancer drugs have access to them. The popular characterization of the United States, where all cancer drugs are available for all to access as and when needed, and that of the British NHS, where top-down population rationing poses insurmountable obstacles to British patients' access, are far from the reality in both countries.
  
  
  CONCLUSIONS
  Key elements of the British system are fairer than the American system, and the British system is better structured to deal with difficult decisions about expensive end-of-life cancer drugs. Both systems face common ethical, financial, organizational, and priority-setting challenges in making these decisions.
authors.affiliation: Johns Hopkins University, Baltimore, MD 21205, USA. rfaden@jhsph.edu
authors.forename: Ruth R
authors.initials: RR
authors.lastname: Faden
authors.forename: Kalipso
authors.initials: K
authors.lastname: Chalkidou
authors.forename: John
authors.initials: J
authors.lastname: Appleby
authors.forename: Hugh R
authors.initials: HR
authors.lastname: Waters
authors.forename: Jonathon P
authors.initials: JP
authors.lastname: Leider
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D017047:Cost Sharing; D003657:Decision Making; D016527:Drug Costs / Q000706:statistics & numerical data; D005252:Fees, Pharmaceutical; D017048:Health Care Costs; D005102:Health Expenditures; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand / Q000191:economics; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy* / Q000191:economics; D010602:Pharmacopoeias as Topic; D006113:United Kingdom; D014481:United States
chemical_list: D000970:Antineoplastic Agents