Health Disparities in Oncology: Western Europe Spends More, Achieves Better Patient Survival Outcomes than Eastern Europe

Audrey Andrews

November 2013, Vol 4, No 9 - Economics of Cancer Care


Amsterdam, The Netherlands—The more a European Union (EU) country spends on health, the fewer the cancer-related deaths occur in that country, and there is a great disparity between Western and Eastern EU countries, according to research presented at the 2013 European Cancer Congress.

Greater wealth and higher health expenditures were strongly associated with decreased cancer mortality, as well as with increased cancer incidence, according to Felipe Ades, MD, a member of the Breast European Adjuvant Studies Team (BrEAST), a clinical trials unit and data center in Belgium.

The higher cancer incidence in Western Europe, and lower death rates, may result from greater access to cancer screening, coupled with more effective treatments, Dr Ades suggested.

He and his colleagues obtained information on populations, cancer incidence, and mortality from the World Health Organization, the International Monetary Fund, and the World Bank Group. They compared the countries’ gross domestic product (GDP) and the percentage of GDP invested in healthcare and health expenditure per person annually with their own estimates of the proportion of patients dying after a cancer diagnosis.

“We have observed that the more spent on health, the fewer the deaths after a cancer diagnosis, and this is specially marked in breast cancer. We have also noticed that, despite all the initiatives to standardize public health policies, there is significant variation between health expenditure and cancer incidence and mortality in the 27 EU member states. This disparity is more glaring between the Western and Eastern European countries,” Dr Ades reported.

East/West Divide
Although the population of Western Europe is approximately 4 times larger than that of Eastern Europe, the western countries’ total GDP is more than 10-fold higher than that of Eastern Europe. These 2 regions also have significantly different health expenditures.

The cutoff point between Eastern and Western European countries for health expenditure per person annually is approximately $2600. For example, among the Western European countries, Portugal has the lowest per-capita expenditure at $2690, whereas in Eastern Europe, Slovenia has the highest per-capita expenditure at $2551. In the West, Luxembourg spent the most per person annually—$6592—whereas in the East, Romania spent the least—$818.

Proportionally, Eastern Europe has a lower cancer incidence and a higher cancer mortality, whereas the opposite is the case in Western Europe. This pattern is strongly associated with health expenditure—the more a country spends on health, the less likely its patients will die after a cancer diagnosis, Dr Ades said.

“In countries spending less than $2000 per capita on healthcare, like Romania, Poland, and Hungary, around 60% of the patients die after a cancer diagnosis. In those spending $2500 to $3500, this figure is around 40% and 50%, as in the case of Portugal, Spain, and the United Kingdom. When countries spend $4000, less than 40% of the patients die, as in the case of France, Belgium, and Germany,” he noted.

José M. Martín-Moreno, MD, PhD, MPH, University of Valencia, Spain, commented on the study. “Cancer is a leading cause of mortality in Europe, and yet there is an important deficit between the resources needed to control it and those deployed to do so,” he said.

The study confirms that funding for health systems is crucial to ensuring good patient outcomes, Dr Martín-Moreno said. “Public health expenditure, along with adequate governance and accountability mechanisms, evidence-based guidelines, and proper capacity-building, are all essential ingredients for a strong health system and for a better society.”