Like nearly everything healthcare-related, the cost of cancer care is high, and getting higher. In the U.S., we spent approximately $124 billion in 2010 to diagnose and treat cancer, approximately 5% of our total healthcare spending. More than 40% of that budget went to treating just 5 cancers—breast, colorectal, lung, prostate cancer, and lymphoma. By 2020, according to a National Cancer Institute study, the annual cost of cancer care could climb to $158 billion (in 2010 dollars). Slowing that increase won’t be easy, and from some perspectives, it might not even be a good idea.
As Sullivan et al point out in a recent article, one of the greatest drivers of cancer cost is innovation, including new approaches to early detection, new drugs, new indications for established drugs, new surgical devices, new radiation technologies, and new diagnostic and monitoring techniques. The last decade has seen some remarkable advances, but they don’t come cheap. Take sipuleucel-T, for example. This targeted therapy extends the lives of patients with metastatic prostate cancer by several months, but at a cost of more than $100,000 for a single course of treatment. Other innovations may add even less benefit for their additional cost. Proton radiation therapy, widely touted as a highly effective treatment for prostate cancer, has been shown to add fewer quality-adjusted life years than traditional stereotactic body radiation therapy, even though it costs more than three times as much.
Another key driver of the cost of cancer care is overutilization of resources. Providing treatment to patients who don’t need it or won’t benefit from it adds cost but not value. Recently, the American Society of Clinical Oncology identified five key opportunities to bring down the cost of cancer care, with a focus on forgoing diagnostic tests for breast and prostate cancer that aren’t expected to yield useful information, and not providing treatments to patients that are unlikely to result in significant benefit.
Patient demand is a third important driver of increasing costs of cancer care, and who can blame a patient who wants the best chance of recovery? Research has shown that patients are often willing to gamble on an innovative new treatment if they believe it offers even a slim chance of longer survival, no matter the cost. Although many are shielded from the cost of treatment by insurance, in general they would be willing to pay higher insurance premiums for a policy that covers high-cost specialty drugs.
It should be asked, however, what we’re getting for all the money we’re spending. As it turns out, there’s a payoff. For years, the U.S. has spent more on healthcare, and more on cancer care, than European countries. From 1983 to 1999, the per-patient cost of cancer care in the U.S. rose from $47,000 to $70,000, a 49% increase. During the same period, the per-patient cost in Europe rose from $38,000 to $44,000, an increase of only 16%. But in return for our money, we’ve enjoyed better survival rates for most types of cancer.
For cancer patients diagnosed between 1995 and 1999, adjusted average survival was 11.1 years in the U.S. and 9.3 years in Europe—an extra 1.8 years of life. In addition, for the period 1983 to 1999, gains in cancer survival in the U.S. have consistently exceeded those in Europe. The net value of the survival gain (using a standard calculation of value per life-year gained) is $61,000 per patient, which exceeds the cost of obtaining that gain. So with cancer, as with many things, sometimes you get what you pay for.
Readers, we want to hear from you!
- Do you consider cost when recommending treatment options to your patients?
- Have you modified your clinical approach to bring down the cost of cancer care?