Abstract
In most countries, the allocation of financial resources for cancer prevention, early detection, and treatment come from different nonrelated “silos.” Primary prevention benefits have the greatest economic return since the cancer benefits are intertwined with other major health conditions. Smoking alone accounts for about one-third cancer deaths. In most affluent countries, vaccines for selected viral caused cancers are (wisely) widely available if not optimally utilized. Estimating the additional cancer burden from obesity is still evolving. Age-targeted, less frequent but higher rates of participation in early detection of cervical, breast, and colorectal cancer will likely be prudent expenditures.
The last 20 years in high-income countries, there has seen an explosion in demand and the costs of cancer drug or biologic therapy, a modest growth in some forms of radiation, yet minimal or declining surgical costs for primary disease control. Expenditures for cancer drugs are now the world leader of any medication category. While a few have truly led to marked benefits, all have been priced at levels that strain or break budgets. We comment on ten steps or principles that can be applied in most countries that can meaningfully reduce cancer care costs with minimal impact on survival and maintain or enhance quality of patient’s life especially with advanced disease. We emphasize limiting systemic therapies for metastatic disease to fully ambulatory patients, those who previously responded to therapy, and earlier initiation of palliative care. Changing behaviors, incentives, expectations, and the framing of treatment effects are necessary to “bend” the current unrelenting cancer care cost curve.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Aaron HJ, Ginsburg PB (2009) Is health spending excessive? If so, what can we do about it? Health Aff 28:1260–1275
Bach PB (2009) Limits on Medicare’s ability to control rising spending on cancer drugs. N Engl J Med 360:626–633
Berry DA, Cronin KA, Plevritis SK et al (2005) Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 353:1784–1792
Cutler DM Making sense of medical technology. (2006) Health Aff 25(2):w48–50
Dodwell D, Thorpe H, Coleman R (2009) Refining systemic therapy for early breast cancer: difficulties with subtraction. Lancet Oncol 10:738–739
Edwards BK, Ward E, Kohler BA et al (2010) Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 116:544–573
Fojo T, Grady C (2009) How much is life worth: cetuximab, non-small cell lung cancer, and the $440 billion question. J Natl Cancer Inst 101:1044–1048
Garber AM, Tunis SR (2009) Does comparative-effectiveness research threaten personalized medicine? N Engl J Med 360:1925–1927
Gavel S (2008) The oncology pipeline: maturing, competitive and growing. oncology business review 2008;September:14–17
Hoffman JM, Shah ND, Vermeulen LC et al (2008) Projecting future drug expenditures – 2008. Am J Health Syst Pharm 65:234–253
Hoffman JM, Shah ND, Vermeulen LC et al (2009) Projecting future drug expenditures – 2009. Am J Health Syst Pharm 66:237–257
Hu JC, Gu X, Lipsitz SR et al (2009) Comparative effectiveness of minimally invasive vs open radical prostatectomy. Jama 302:1557–1564
Iglehart JK (2009) Prioritizing comparative-effectiveness research – IOM recommendations. N Engl J Med 361:325–328
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ (2009) Cancer statistics, 2009. CA Cancer J Clin 59:225–49
Mandelblatt JS, Cronin KA, Bailey S et al (2009) Effects of mammography screening under different screening schedules: model estimates of potential benefits and harms. Ann Intern Med 151:738–747
Meropol NJ, Schulman KA (2007) Cost of cancer care: issues and implications. J Clin Oncol 25:180–186
Meropol NJ, Schrag D, Smith TJ, et al. (2009) American Society of Clinical Oncology Guidance Statement: the cost of cancer care. J Clin Oncol JCO.2009.23.1183
Mitchell JM (2008) Utilization trends for advanced imaging procedures: evidence from individuals with private insurance coverage in California. Med Care 46:460–466
Murray CJL, Frenk J (2010) Ranking 37th – measuring the performance of the US Health Care System. N Engl J Med 362:98–99
NHPCO Facts and Figures: Hospice Care in America. National Hospice and Palliative Care Organization. less.http://www.nhpco.org/files/public/Statistics_Research/NHPCO_facts_and_figures.pdfAccessed March 12, 2010
Peeters A, Grutters JPC, Pijls-Johannesma M et al (2010) How costly is particle therapy? Cost analysis of external beam radiotherapy with carbon-ions, protons and photons. Radiother Oncol. 2010 Apr;95(1):45–53. Epub 2010 Jan 26
Siminoff LA, Fetting JH (1989) Effects of outcome framing on treatment decisions in the real world: Impact of framing on adjuvant breast cancer decisions. Med Dec Making 9(4):262–271
Smith T, Hillner B (2010) Concrete options and ideas for increasing value in oncology care: the view from one trench. Oncologist. 2010;15 Suppl 1:65–72
Steinbrook R (2008) Saying no isn’t NICE – the travails of Britain’s National Institute for Health and Clinical Excellence. N Engl J Med 359:1977–1981
Yabroff KR, Lamont EB, Mariotto A et al (2008) Cost of care for elderly cancer patients in the United States. J Natl Cancer Inst 100:630–641
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2010 Springer Berlin Heidelberg
About this chapter
Cite this chapter
Hillner, B.E., Smith, T.J. (2010). Allocating Cancer-Directed Expenditures: Tensions Between Prevention, Early Detection and Treatment is Unnecessary. In: Senn, HJ., Otto, F. (eds) Clinical Cancer Prevention. Recent Results in Cancer Research, vol 188. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-10858-7_1
Download citation
DOI: https://doi.org/10.1007/978-3-642-10858-7_1
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-10856-3
Online ISBN: 978-3-642-10858-7
eBook Packages: MedicineMedicine (R0)