The US spends more on cancer care than European countries, but this investment generates greater "value" for US patients, who typically live nearly two years longer than their European counterparts, a new study suggests.
During 1983-1999, the cost of cancer treatment in the US was higher than in 10 European countries, but for most cancer types investigated, US patients lived longer than their European counterparts, according to Tomas Philipson, the Daniel Levin Chair in Public Policy at the University of Chicago, and his co-authors, reporting their findings in the current issue of Health Affairs.
Cancer patients diagnosed during 1995-99 lived on average 11.1 years after diagnosis in the US, compared to 9.3 years from diagnosis in Europe, they write.
The researchers conclude that, by standard metrics which value additional years of life in dollar terms, US cancer patients paid more but achieved better results in terms of longevity. Even after considering higher US costs for treatment, their calculations showed the extra longevity was worth an aggregate of $598 billion - averaging $61,000 for an individual cancer patient.
The value of additional survival gains was highest for patients with prostate cancer, at $627 billion, and breast cancer patients, at $173 billion, they add.
These findings suggest that the higher-cost US system of cancer care delivery may be "worth it" in terms of the longer survival it delivered, although further research is required to determine what specific tools or treatments are driving improved cancer survival in the US, say the authors.
The current issue of Health Affairs includes a number of other articles examining the costs and benefits of US cancer care and the value to patients of longer survival. One, an analysis by Darius Lakdawalla of the Leonard Schaeffer Center for Health Policy and Economics at the University of Southern California, et al, shows that 77% of surveyed cancer patients preferred "hopeful gambles" - treatments that offer a 50% chance of adding three years to their survival but also a 50% chance of no additional survival - to "safe bet" treatments that would keep them alive for 18 months.
Another, by Seth Seabury at the RAND Corporation and co-authors, examined the treatment choices of terminally-ill cancer patients to find out how much they valued certain kinds of care. They found that patients were willing to pay a price for treatment of metastatic cancer that was, on average, 23 times higher than its actual cost, This gap indicates that traditional methods used to estimate the value of treatments for terminal illness may need to be revisited, they comment.
Healthy people responding to a survey were willing to pay more in insurance premiums for generous coverage of high-cost drugs that treat cancer and other serious diseases, report John Romley at the University of Southern California and colleagues. The cost of covering specialty drugs is about $5 per month, but the survey respondents were willing to pay $12.94 per month for the coverage, they found.
And a survey of oncologists in the US and Canada about the value of expensive cancer drugs in relation to gains in survival found that the physicians were not consistent in their opinions about how many months an expensive new therapy should extend a person's life before the cost of therapy is justified. The authors, Peter Ubel of Duke University et al, call for physicians to be provided with clinical guidelines to help them factor cost and value into decisions about treatment.
Cancer care has raised unique issues for countries and other entities which conduct evaluations to help inform coverage and reimbursement decisions, and some countries have granted cancer treatments special status when it comes to such technology assessments, a paper by Peter Neumann and colleagues at Tufts Medical Center points out.
Some nations have created special pathways for these reviews, while others have exceptions to provide better access to cancer treatments; in the US, Medicare grants special status to cancer in paying for off-label uses of cancer treatments, under unique rules not used for other drugs, they write.
"Worldwide, we demonstrate that health technology assessment organisations are struggling with cancer's 'exceptionalism'," the authors conclude.