Delivering affordable cancer care in high-income countries

Sullivan, Richard and Peppercorn, Jeffrey and Sikora, Karol and Zalcberg, John and Meropol, Neal J and Amir, Eitan and Khayat, David and Boyle, Peter and Autier, Philippe and Tannock, Ian F and Fojo, Tito and Siderov, Jim and Williamson, Steve and Camporesi, Silvia and McVie, J Gordon and Purushotham, Arnie D and Naredi, Peter and Eggermont, Alexander and Brennan, Murray F and Steinberg, Michael L and De Ridder, Mark and McCloskey, Susan A and Verellen, Dirk and Roberts, Terence and Storme, Guy and Hicks, Rodney J and Ell, Peter J and Hirsch, Bradford R and Carbone, David P and Schulman, Kevin A and Catchpole, Paul and Taylor, David and Geissler, Jan and Brinker, Nancy G and Meltzer, David and Kerr, David and Aapro, Matti (2011) Delivering affordable cancer care in high-income countries. Lancet Oncology, 12 (10). pp. 933-980.

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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.