Delivering Affordable, Evidence-Based Cancer Care in High-Income Countries

Caroline Helwick

December 2011, Vol 2, No 7 - ESMO 2011 Conference


Stockholm, Sweden—A consortium of world cancer specialists, economists, and policymakers is tackling the issue of equitable cancer care in the face of rising cost of care in high-income countries. Their report (Sullivan R, et al. Lancet Oncol. 2011;12:933-980) coincided with a key presentation at the 2011 European Multidisciplinary Cancer Congress.

The report focused on the delivery of equitable and affordable care in the United States, Europe, Canada, Australia, and New Zealand.

Richard Sullivan, MD, PhD, from Kings Health Partners at King’s College Integrated Cancer Centre, Guy’s Campus Hospital, London, who spoke at the Presidential Session, said the problem is urgent. “Affordable cancer care needs to be at the heart of policy discussions now,” he emphasized, adding, “There is internal panic regarding what we should do.”

A $300-Billion Problem
The Economist Intelligence Unit estimates the costs associated with new cancer cases alone (worldwide) in 2009 to be at least $286 billion ($107 billion in the United States). Medical costs make up more than 50% of the economic burden, and productivity losses account for nearly 25% of the burden. By 2030, there will be an estimated 22 million new patients with cancer annually worldwide, which will greatly exacerbate the problem.

“The global challenge to countries is how to deliver reasonably priced cancer care to all citizens in a way that respects what patients want,” Dr Sullivan said.

The massive increase in expenditure on cancer care in high-income countries over the past 2 decades results from many factors: overutilization (eg, tests that are useful in one setting but not another), high-cost innovations, disincentives driven by reimbursement rules and defensive medical practice (more tests and treatment to counter a litigation-driven culture), consumer-driven overdemand, and futile overtreatment at the end of life, the panel concluded.

“Radical Action Is Needed”
The panel identified a range of immediate and medium-term measures that could be introduced to reduce the current cost base and to manage the future cost curves of particularly expensive interventions.

For one thing, radical action is needed, they said, to simplify and integrate patient treatment pathways and new models of care with lower cost bases. A new approach to costly interventions must be driven through healthcare systems. These would range from mandatory cost-effectiveness analysis to the prohibition of off-label use and new economic models for reimbursement and incentivization.

“The cancer profession and industry should also take responsibility and not accept an ethos of very small benefit at whatever cost. Rather we need delivery of fair prices and real value from new technologies,” Dr Sullivan said.

Introducing Value into Patient Care
It is also important to bring these issues to the public. “Making individual patients more sensitive to the costs of care is necessary for an informed public debate around the critical issues,” Dr Sullivan pointed out. “We need to educate the public that valuebased cancer care is not poor care.”

“Getting technology to the patient faster” is an existing concept that must be rethought. In the current healthcare culture, patients want immediate rewards, particularly novel therapies,” he said, but this is a cost-driver.

Individuals should also take more responsibility for their own health, and make lifestyle changes in keeping with cancer prevention, the panel suggested.

Billions of dollars could be saved in the treatment of lung cancer alone, by smoking prevention. “The question is how to incentivize both professionals and patients to engage in cost-effectiveness treatments and behaviors that will prevent cancer,” according to Dr Sullivan.

The panel observed that too many non–evidence-based approaches are being taken and “ad hoc decisions” are being made at the local level. “This must stop,” he commented.

“We believe that value and affordable cancer care can be introduced into the cancer policy lexicon, without detracting from quality, and that the management tools, evidence, and methods are available to affect this transformation across all developed countries,” Dr Sullivan concluded.

President of the European Cancer Organization, Michael Baumann, MD, commented, “It is of the utmost importance that oncology professionals promote evidence-based discussion of the economics of cancer care. This can only be safeguarded by transparent and evidence- based analysis and policy development. This initiative is a very important step in this direction.”