New analysis reexamines the value of cancer care in the United States compared to Western Europe.
Despite sharp increases in spending on cancer treatment since 1970 in the United States compared to Western Europe, US cancer mortality rates have decreased only modestly. This has raised questions about the additional value of US cancer care derived from this additional spending. We calculated the number of US cancer deaths averted, compared to the situation in Western Europe, between 1982 and 2010 for twelve cancer types. We also assessed the value of US cancer care, compared to that in Western Europe, by estimating the ratio of additional spending on cancer to the number of quality-adjusted life-years saved. Compared to Western Europe, for three of the four costliest US cancers-breast, colorectal, and prostate-there were approximately 67,000, 265,000, and 60,000 averted US deaths, respectively, and for lung cancer there were roughly 1,120,000 excess deaths in the study period. The ratio of incremental cost to quality-adjusted life-years saved equaled $402,000 for breast cancer, $110,000 for colorectal cancer, and $1,979,000 for prostate cancer-amounts that exceed most accepted thresholds for cost-effective medical care. The United States lost quality-adjusted life-years despite additional spending for lung cancer: -$19,000 per quality-adjusted life-year saved. Our results suggest that cancer care in the United States may provide less value than corresponding cancer care in Western Europe for many leading cancers.
Samir Soneji (samir.soneji@dartmouth.edu) is an assistant professor at the Dartmouth Institute for Health Policy and Clinical Practice and a member of the Norris Cotton Cancer Center, both in Lebanon, New Hampshire.
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JaeWon Yang was an undergraduate at Dartmouth College, in Hanover, New Hampshire, at the time this article was written.
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D000328:Adult; D001943:Breast Neoplasms / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000628:therapy; D015179:Colorectal Neoplasms / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000628:therapy; D017281:Cost of Illness; D016208:Databases, Factual; D005060:Europe; D005260:Female; D017048:Health Care Costs; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011471:Prostatic Neoplasms / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000628:therapy; D019057:Quality-Adjusted Life Years; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States
Cost of Health Care; Demography; Developed World < International/global health studies; Epidemiology; Health Economics