Along with Heart Disease, Cancer is one of the primary causes of death worldwide and while Heart Disease can be treated with surgery and lifestyle changes, it's even been theorized that an elderly person would eventually die of cancer if nothing else ails them first. It's therefore rather alarming to read that cancer treatments are becoming impossibly expensive.
In 2008 it was estimated that the worldwide cost of cancer due to premature death and disability, not including the patient's medical costs, was nearly One Trillion dollars, and the thought of being diagnosed with cancer strikes fear into most people. It's clearly public enemy number one in terms of healthcare, thus a bad situation is made far worse if cancer care becomes a luxury only the rich can afford.
That is the crux of a new report in the Lancet Oncology Commission, which includes a broad spectrum of experts chosen not only from doctors but patient groups and economists alike. They are considered among the world's top cancer specialists.
Professor Richard Sullivan from the King's Health Partners Integrated Cancer Centre (a collaboration between King's College London and its partner NHS Foundation Trusts " Guy's and St Thomas' and King's College Hospital, London, UK) said when presenting the report to the 2011 European Multidisciplinary Cancer Congress, that populations with a larger percentage of elderly combined with the increasing complexity and cost of new cancer treatments, means the issue needs urgent examination.
"The Economist Intelligence Unit estimates the costs associated with new cancer cases alone in 2009 to be at least $286 billion. Medical costs make up more than half the economic burden, and productivity losses account for nearly a quarter. By 2030, there will be an estimated 22 million new patients with cancer per year worldwide," he said. "The global challenge to countries is how to deliver reasonably priced cancer care to all citizens " i.e. make cancer care affordable to individuals and society."While cancer patient numbers are seen growing in low and middle income countries it may seem odd to focus on the wealthier nation's cancer profile. However the world's most developed nations provide a clear picture due to the fact that they lack the prevalence of both acute and chronic infectious diseases that make for more complex scenarios in less developed countries. Furthermore it is easier to identify why costs have mushroomed in the richer nations, examples include:
- over-utilisation (for example, tests which are useful in one setting and not in another)
- high-cost innovation
- disincentivisation driven by reimbursement rules
- defensive medical practice " more tests and treatment to counter litigation-driven culture " consumer-driven over-demand
- futile over-treatment at the end of life
Extensive actions should be taken to streamline the process of treating cancer patients that basically encompass a new approach to expensive patient by patient interventions. This includes mandatory cost-effectiveness analysis and the prohibition of off-label use and new economic models for reimbursement and incentivisation.
The importance of educating the public, patients and policymakers about the main issues in providing affordable cancer care is also essential, say the authors:
"Making individual patients more sensitive to the costs of care is necessary for an informed public debate around this critical issue," said Professor Sullivan.
Furthermore they state that political blindness to the unfairness in access to cancer treatment at reasonable costs should no longer be tolerated. The community of doctors, patients, care providers, and patient support groups should not put up with poor evidence or the idea that treatments with small benefits should be carried out regardless of cost. Fair prices and genuine value from new technologies must be the goal.
Professor Sullivan continues that:
"We are at a crossroads for affordable cancer care, where our choices "or refusal to make choices" will affect the lives of millions of people. Do we bury our heads in the sand, keep our fingers crossed, and hope that it turns out fine, or do we have difficult debates and make hard choices within a socially responsible, cost-effective, and sustainable framework? The consensus from all those involved is that policy makers, politicians, patients, and health care professionals need to address this issue now."And he concludes that:
"We believe that value and affordable cancer care can be introduced into the cancer policy lexicon without detracting from quality, and that the management tools, evidence, and methods are available to affect this transformation across all developed countries."ECCO President Professor Michael Baumann added that:
"It is of the utmost importance that oncology professionals promote evidence-based discussion of the economics of cancer care. All health systems face budget limitations, while at the same time the cancer burden and expenditures are increasing steeply. Every cancer patient, now and in the future, must have fair access to quality cancer care and to innovation. This can only be safeguarded by transparent and evidence-based analysis and policy development. This initiative by Lancet Oncology is a very important step in this direction."