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Oncology pp 151–160Cite as

Economics of Cancer Care

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Abstract

Several major issues emerge when combining the “dismal science” of economics1 with the science of oncology. With rising healthcare costs yet limited resources, it becomes important to know how to factor economic considerations into the medical decision-making process. This task is made more difficult by the paucity of comparative studies of costs and outcomes (under the general term of cost-effectiveness) and quality of life; as a result, clinicians are left on their own to decide “who does what to whom, at what cost, and with whose money.”

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References

  1. Smith A. An inquiry into the nature and causes of the wealth of nations. In: Cannan E (ed). London: Methuen, 1904:1723–1790.

    Google Scholar 

  2. Lamm RD. The ghost of health care future. Inquiry 1994;31:365–367.

    PubMed  Google Scholar 

  3. Smith TJ, Hillner BE, Desch CE. Efficacy and cost-effectiveness of cancer treatment: rational allocation of resources based on decision analysis. JNCI 1993;85:1460–1474.

    Article  PubMed  CAS  Google Scholar 

  4. Bochner F, Martin ED, Burgess ND, Somogyi AA, Misan GM: How can hospitals ration drugs? Drug rationing in a teaching hospital: a method to assign priorities. Drug Committee of the Royal Adelaide Hospital. BMJ 1994;308:901–905.

    PubMed  CAS  Google Scholar 

  5. Smith TJ, Bodurtha JN. Ethical considerations in oncology: balancing the interests of patients, oncologists, and society. J Clin Oncol 1995;13(9):2464–2470.

    PubMed  CAS  Google Scholar 

  6. Schrag D. The price tag on progress: chemotherapy for colorectal cancer. N Engl J Med 2004;351(4):317–319.

    Article  PubMed  CAS  Google Scholar 

  7. Druker BJ. Imatinib alone and in combination for chronic myeloid leukemia. Semin Hematol 2003;40(1):50–58.

    Article  PubMed  CAS  Google Scholar 

  8. Bennett CL, Smith TJ, George SL, Hillner BE, Fleishman S, Niell HB. Free-riding and the prisoner’s dilemma: problems in funding economic analyses of phase III cancer clinical trials. J Clin Oncol 1995;13:2457–2463.

    PubMed  CAS  Google Scholar 

  9. Tamburini M, Buccheri G, Brunelli C, Ferrigno D. The difficult choice of chemotherapy in patients with unresectable non-small cell lung cancer. Support Care Cancer 2000;8(3):223–228.

    Article  PubMed  CAS  Google Scholar 

  10. Slevin ML, Stubbs L, Plant HJ, et al. Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses, and general public. BMJ 1990;300:1458–1460.

    PubMed  CAS  Google Scholar 

  11. Balmer CE, Thomas P, Osborne RJ. Who wants second-line, palliative chemotherapy? Psycho-Oncology 2001;10:410–418.

    Article  PubMed  CAS  Google Scholar 

  12. Bremnes RM, Andersen K, Wist EA. Cancer patients, doctors and nurses vary in their willingness to undertake cancer chemotherapy. Eur J Cancer 1995;31A(12):1917–1918.

    Google Scholar 

  13. Davies E, Clarke C, Hopkins A. Malignant cerebral glioma. I: Survival, disability, and morbidity after radiotherapy. BMJ 1996;313:1507–1512.

    PubMed  CAS  Google Scholar 

  14. Davies E, Clarke C, Hopkins A. Malignant cerebral glioma. II: Perspectives of patients and relatives on the value of radiotherapy. BMJ 1996;313:1512–1516.

    PubMed  CAS  Google Scholar 

  15. Meystre CJN, Burley NMJ, Ahmedzai S. What investigations and procedures do patients in hospices want? Interview based survey of patients and their nurses. BMJ 1997;315:1202–1203.

    PubMed  CAS  Google Scholar 

  16. Silvestri G, Pritchard R, Welch HG. Preferences for chemotherapy in patients with advanced non-small cell lung cancer: descriptive study based on scripted interviews. BMJ 1998;317(7161):771–775.

    PubMed  CAS  Google Scholar 

  17. Siegel JE, Weinstein MC, Russell LB, Gold MR. Recommendations for reporting cost-effectiveness analyses. JAMA 1996;276(16):1339–1341.

    Article  PubMed  CAS  Google Scholar 

  18. O’Leary JF, Fairclough DL, Jankowski MK, Weeks JC. Comparison of time-trade-off utilities and rating scale values of cancer patients and their relatives: evidence for a possible plateau relationship. Med Decis Making 1995;15:132–137.

    Article  PubMed  CAS  Google Scholar 

  19. Tunis SR. Why Medicare has not established criteria for coverage decisions. N Engl J Med 2004;350:2196–2198.

    Article  PubMed  CAS  Google Scholar 

  20. Barton MB, Jacob SA, Gebsky V. Utility-adjusted analysis of the cost of palliative radiotherapy for bone metastases. Australas Radiol 2003;47:274–278.

    Article  PubMed  Google Scholar 

  21. Russell LB, Gold MR, Siegel JE, Daniels N, Weinstein MC. The role of cost-effectiveness analysis in health and medicine. JAMA 1996;276(14):1172–1177.

    Article  PubMed  CAS  Google Scholar 

  22. Toner GC, Shapiro JD, Laidlaw CR, et al. Low-dose versus standard-dose lenograstim prophylaxis after chemotherapy: a randomized, crossover comparison. J Clin Oncol 1998;16:3874–3879.

    PubMed  CAS  Google Scholar 

  23. Juan O, Campos JM, Caranana V, Sanchez JJ, Casan R, Alberola V. A randomized, crossover comparison of standard-dose versus low-dose lenograstim in the prophylaxis of post-chemotherapy neutropenia. Support Care Cancer 2001;9(4):241–246.

    Article  PubMed  CAS  Google Scholar 

  24. Smith TJ, Staats PS, Deer T, et al. Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. J Clin Oncol 2002;20:4040–4049.

    Article  PubMed  CAS  Google Scholar 

  25. Hoover DR, Crystal S, Kumar R, Sambamoorthi U, Cantor JC. Medical expenditures during the last year of life: findings from the 1992–1996 Medicare Current Beneficiary Survey. Health Serv Res 2002;37(6):1625–1642.

    Article  PubMed  Google Scholar 

  26. Verboom P, van Tinteren H, Hoekstra OS, et al. PLUS study group. Cost-effectiveness of FDG-PET in staging non-small cell lung cancer: the PLUS study. Eur J Nucl Med Mol Imaging 2003;30(11):1444–1449.

    Article  PubMed  Google Scholar 

  27. van Smit EF, Meerbeeck JP, Lianes P, et al. Three-arm randomized study of two cisplatin-based regimen and paclitaxel plus gemcitabine in advanced non-small-cell lung cancer: a phase III trial of the European Organization for Research and Treatment of Cancer Lung Cancer Group-EORTC 08975. J Clin Oncol 2003;21(21):3909–3917.

    Article  PubMed  CAS  Google Scholar 

  28. Smith TJ, Cassel JB, Coyne PJ, Hager MA. Quality of care and cost savings associated with an inpatient high volume, standardized-care palliative care unit. J Palliat Med 2003; (in press).

    Google Scholar 

  29. O’Shaughnessy J, Miles D, Vukelja S, et al. Superior survival with capecitabine plus docetaxel combination therapy in anthracycline-pretreated patients with advanced breast cancer: Phase III trial results. J Clin Oncol 2002;20:2812–2823.

    Article  PubMed  CAS  Google Scholar 

  30. Verma S, Ilersich AL. Population-based pharmacoeconomic model for adopting capecitabine/docetaxel combination treatment for anthracycline-pretreated metastatic breast cancer. Oncologist 2003;8:232–240.

    Article  PubMed  Google Scholar 

  31. Abernethy AP, Samsa GP, Matchar DB. A clinical decision and economic analysis model of cancer pain management. Am J Manag Care 2003;9(10):651–664.

    PubMed  Google Scholar 

  32. Van den Hout W, van der Linden YM, Steenland E, et al. Single versus multiple-fraction radiotherapy in patients with painful bone metastases: cost-utility analysis based on a randomized trial. JNCI 2003;95:222–229.

    PubMed  Google Scholar 

  33. Gordois A, Schuffham P, Warren E, Ward S: Cost-utility analysis of imatinib mesilate for the treatment of advanced stage chronic myeloid leukaemia. Br J Cancer 2003;89:634–640.

    Article  PubMed  CAS  Google Scholar 

  34. Elkin EB, Weinstein MC, Winer EP, Kuntz KM, Schnitt SJ, Weeks JC. HER-2 testing and trastuzumab therapy for metastatic breast cancer: a cost-effectiveness analysis. J Clin Oncol 2004;22(5):854–863.

    Article  PubMed  Google Scholar 

  35. Hillner BE, Smith TJ. Does a clinical trial warrant an economic analysis? JNCI 1998;90(10):724–725.

    Article  PubMed  CAS  Google Scholar 

  36. McGuire WL, Abeloff MD, Fisher B, Glick JH, Henderson IC, Osborne CK. Adjuvant therapy in node-negative breast cancer. A panel discussion. Breast Cancer Res Treat 1989;13:97–115.

    Article  PubMed  CAS  Google Scholar 

  37. Hillner BE, Smith TJ. Efficacy and cost-effectiveness of adjuvant chemotherapy in women with node-negative breast cancer. A decision analysis model. N Engl J Med 1991;324:160–168.

    Article  PubMed  CAS  Google Scholar 

  38. Smith TJ, Hillner BE. The efficacy and cost-effectiveness of adjuvant therapy of early breast cancer in premenopausal women. J Clin Oncol 1993;11:771–776.

    PubMed  CAS  Google Scholar 

  39. Jaakimainen L, Goodwin PJ, Pater J, Warde P, Murray N, Rapp E. Counting the costs of chemotherapy in a National Cancer Institute of Canada randomized trial in non-small cell lung cancer. J Clin Oncol 1990;8:1301–1309.

    Google Scholar 

  40. Smith TJ, Hillner BE, Neighbors DM, McSorley PA, Le Chevalier T. An economic evaluation of a randomized clinical trial comparing vinorelbine, vinorelbine plus cisplatin and vindesine plus cisplatin for non-small cell lung cancer. J Clin Oncol 1995;13:2166–2173.

    PubMed  CAS  Google Scholar 

  41. Tannock IF, Osoba D, Stockler MR, et al. Chemotherapy with mitoxantrone plus prednisone or prednisone alone for symptomatic hormone-resistant prostate cancer: a Canadian randomized trial with palliative end points. J Clin Oncol 1996;14(6):1756–1764.

    PubMed  CAS  Google Scholar 

  42. Bloomfield DJ, Krahn MD, Neogi T et al. Economic evaluation of chemotherapy with mitoxantrone plus prednisone for symptomatic hormone resistant prostate cancer, based on a Canadian randomized trial with palliative endpoints. J Clin Oncol 1997;16:2272–2279.

    Google Scholar 

  43. Royle P, Waugh N. Literature searching for clinical and cost-effectiveness studies used in health technology assessment reports carried out for the National Institute for Clinical Excellence appraisal system. Health Technol Assess 2003;7(34):1–51.

    Google Scholar 

  44. Mason J, Drummond M, Torrance G. Some guidelines on the use of cost-effectiveness league tables. BMJ 1993;306:570–572.

    Article  PubMed  CAS  Google Scholar 

  45. Ubel PA, Hirth RA, Chernew ME, et al. What is the price of life and why doesn’t it increase at the rate of inflation? Arch Intern Med 2003;163:1637–1641.

    Article  PubMed  Google Scholar 

  46. Laupacis A, Feeny D, Detsky AS, Tugwell PX. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluation. Can Med Assoc J 1992;146:473–481.

    CAS  Google Scholar 

  47. Friedman E. Capitation, integration, and managed care. Lessons from early experiments. JAMA 1996;275:957–962.

    Article  PubMed  CAS  Google Scholar 

  48. Hartman M, Knoth H, Schulz D, Knoth S. Industry-sponsored economic studies in oncology versus studies sponsored by nonprofit organizations. Br J Cancer 2003;89(8):1405–1408.

    Article  Google Scholar 

  49. Knox KS, Adams JR, Djulbegovic B, Stinson TJ, Tomor C, Bennett CL. Reporting and dissemination of industry versus non-profit sponsored economic analyses of six novel drugs used in oncology. Ann Oncol 2000;11:1591–1595.

    Article  PubMed  CAS  Google Scholar 

  50. Sulmasy DP. Physicians, cost control, and ethics. Ann Intern Med 1992;116:920–926.

    PubMed  CAS  Google Scholar 

  51. Callahan D. Controlling the costs of health care for the elderly—fair means and foul. N Engl J Med 1996;335:744–746.

    Article  PubMed  CAS  Google Scholar 

  52. Levinsky NG. The purpose of advance medical planning—autonomy for patients or limitation of care? N Engl J Med 1996;335:741–743.

    Article  PubMed  CAS  Google Scholar 

  53. Hadorn DC. The Oregon priority-setting exercise: quality of life and public policy. Hastings Cent Rep 1991;21(suppl):11–16.

    PubMed  Google Scholar 

  54. Earle CC, Chapman R, Baker C, et al. Systematic overview of cost-utility assessments in oncology. J Clin Oncol 2000;18:3302–3317.

    PubMed  CAS  Google Scholar 

  55. Drummond M, Stoddart G, Labelle R, Cushman R. Health economics: an introduction for clinicians. Ann Intern Med 1987;107:88–92.

    PubMed  CAS  Google Scholar 

  56. Kouroukis CT, O’Brien BJ, Benger A, et al. Cost-effectiveness of a transplantation strategy compared to melphalan and prednisone in younger patients with multiple myeloma. Leuk Lymphoma 2003;44(1):29–37.

    Article  PubMed  CAS  Google Scholar 

  57. Fuchs VR, Garber AM. The new technology assessment. N Engl J Med 1990;323:673–677.

    Article  PubMed  CAS  Google Scholar 

  58. Evans RW. Cost-effectiveness analysis of transplantation. Surg Clin N Am 1986;66:603–616.

    PubMed  CAS  Google Scholar 

  59. Hillner BE, Weeks JC, Desch CE, Smith TJ. Pamidronate in prevention of bone complications in metastatic breast cancer: a cost-effectiveness analysis. J Clin Oncol 2000;18:72–79.

    PubMed  CAS  Google Scholar 

  60. Hayman JA, Hillner BE, Harris JR. Cost-effectiveness of routine radiation therapy following conservative surgery for early-stage breast cancer. J Clin Oncol 1998;16:1022–1029.

    PubMed  CAS  Google Scholar 

  61. Lee JH, Glick HA, Hayman JA, et al. Decision-analytic model and cost-effectiveness evaluation of postmastectomy radiation therapy in high-risk premenopausal breast cancer patients. J Clin Oncol 2002;20:2713–2725.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Internal Medicine, Division of Hematology/Oncology, Virginia Commonwealth University Health System, Richmond, VA, USA

    James Khatcheressian MD (Assistant Professor) & Thomas J. Smith MD (Professor and Chairman)

Authors
  1. James Khatcheressian MD
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  2. Thomas J. Smith MD
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Editor information

Editors and Affiliations

  1. Division of Surgery Oncology, Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    Alfred E. Chang MD (Hugh Cabot Professor of Surgery and Chief) (Hugh Cabot Professor of Surgery and Chief)

  2. Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA

    Daniel F. Hayes MD (Clinical Director) (Clinical Director)

  3. Department of Cardiothoracic Surgery, New York University School of Medicine and Comprehensive Cancer Center, New York, NY, USA

    Harvey I. Pass MD (Professor and Chief of Thoracic Surgery and Head) (Professor and Chief of Thoracic Surgery and Head)

  4. Thoracic Oncology, New York University School of Medicine and Comprehensive Cancer Center, New York, NY, USA

    Harvey I. Pass MD (Professor and Chief of Thoracic Surgery and Head) (Professor and Chief of Thoracic Surgery and Head)

  5. Department of Medicine, Harvard Medical School, USA

    Richard M. Stone MD (Associate Professor and Clinical Director) (Associate Professor and Clinical Director)

  6. Adult Leukemia Program, Dana-Farber Cancer Institute, Boston, MA, USA

    Richard M. Stone MD (Associate Professor and Clinical Director) (Associate Professor and Clinical Director)

  7. Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center at UCLA, USA

    Patricia A. Ganz MD (American Cancer Society Clinical Research Professor, Director and Professor) (American Cancer Society Clinical Research Professor, Director and Professor)

  8. Schools of Public Health and Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    Patricia A. Ganz MD (American Cancer Society Clinical Research Professor, Director and Professor) (American Cancer Society Clinical Research Professor, Director and Professor)

  9. Department of Radiation Oncology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA

    Timothy J. Kinsella MD (Vincent K. Smith Professor and Chairman) (Vincent K. Smith Professor and Chairman)

  10. Department of Medicine, University of Wisconsin Comprehensive Cancer Center, Madison, WI, USA

    Joan H. Schiller MD (Melanie Heald Professor of Medical Oncology) (Melanie Heald Professor of Medical Oncology)

  11. Health Media Research Laboratory, Department of Health Behavior and Health Education, University of Michigan School of Public Health, USA

    Victor J. Strecher PhD, MPH (Professor and Director and Associate Director) (Professor and Director and Associate Director)

  12. Cancer Prevention and Control, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA

    Victor J. Strecher PhD, MPH (Professor and Director and Associate Director) (Professor and Director and Associate Director)

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Khatcheressian, J., Smith, T.J. (2006). Economics of Cancer Care. In: Chang, A.E., et al. Oncology. Springer, New York, NY. https://doi.org/10.1007/0-387-31056-8_11

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  • DOI: https://doi.org/10.1007/0-387-31056-8_11

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-24291-0

  • Online ISBN: 978-0-387-31056-5

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