Do you 'get what you pay for' when it comes to cancer care?

Seems the answer is yes



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Americans may pay more for cancer treatment, but they also live longer after diagnosis — getting a benefit that offsets their higher health expenses.


Policy Research at the University of Chicago suggests the answer may be yes, at least when it comes to cancer care.

“We found that the value of the survival gains greatly outweighed the costs, which suggests that the costs of cancer care were indeed “worth it,” wrote University of Chicago public policy researcher Tomas Philipson and colleagues, in a paper published by the journal Health Affairs.

So is it worth it in Britain?

With all the talk in the media about costs of cancer care, isn’t it about time we turned this around, and worked out what benefits are gained by helping people live longer?

Cancer patients are constantly being told that a drug is too expensive to be given to everyone who needs it – but shouldn’t we turn the tables and work out the benefits to family and work in the equation?  That person who has the very expensive drug that prolongs their life – might they not still be raising children and contributing to the profitability of the company they work for?

What happened in the States

To examine whether the higher costs were “worth it,” Philipson and his team mined extensive databases to compare cancer treatment costs and cancer survival data in the U.S. with those in 10 countries that represend 36% of the population of the European Union: Finland, France, Germany, Iceland, Norway, Slovakia, Slovenia and Sweden, as well as Scotland and Wales.

First, the team examined the costs — and found that Americans spend much more on cancer care than Europeans, with U.S. spending increasing 49%, from $47,000 per case to $70,000 per case (in 2010 dollars,) between 1983 and 1999.  In the European countries, spending grew 16% over the same period, from $38,000 to $44,000.

Then they looked at survival data for patients with types of cancer, including breast, prostate, colorectal and blood cancers, among others.  Comparing length of time from diagnosis to death, as well as differences in survival gains over time, they discovered that among patients diagnosed from 1995 to 1999, average survival in the U.S was 11.1 years and in the European countries studied was 9.3 years.   These statistics might seem old, but when carrying out research to get a broad picture often older statistics have to be used.

Finally, the team used a standard method to put a “conservative” monetary value on the extra longevity of $150,000 per year.  Crunching all the numbers, they found that the extra years Americans enjoyed amounted to $598 billion worth of benefit over the period studied — about $61,000, on average, per patient.

“A key question for policy makers is whether the U.S. survival gains are actually produced by higher U.S. spending on cancer care or by some other factor unrelated to the healthcare delivery system,” the team wrote, cautioning that the analysis does not prove that all treatments are cost-effective.   

However, as David Cameron and Andrew Lansley are always reminding us, UK cancer survival rates lag behind those in France – so would seem they agree with Philipson.

One influencing factor might be the faster adoption of new technologies in the U.S., the authors wrote. Their paper was accompanied by several more articles exploring the costs and benefits of U.S. cancer care.  This would find favour with medical guru Lord Darzi, who has been heard to ask “what good is NICE?”

So next time some politician or NHS administrator tries to refuse use of a drug – get them to work out the long-term benefits;  these might add weight to what can be an emotive subject.


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