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Study Finds U.S. Spends More on Cancer Care but Saves Fewer Lives Than Western Europe

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Key Points

  • U.S. cancer mortality rates have decreased by 12% since 1970.
  • The U.S. experienced 1,120,000 excess lung cancer deaths from 1982 to 2010 when compared to Western Europe.
  • The ratio of incremental cost to quality-adjusted life-years in the United States exceeds most accepted thresholds for cost-effective medical care.

Despite sharp increases in spending on cancer treatment, cancer mortality rates in the United States have decreased only modestly since 1970. Researchers led by Samir Soneji, PhD, of Dartmouth's Norris Cotton Cancer Center and The Dartmouth Institute for Health Policy & Clinical Practice published these findings, which refute previous studies, in an article authored by Dr. Soneji and JaeWon Yang in Health Affairs.

U.S. Cancer Spending and Mortality

“Our results suggest that cancer care in the United States did not always avert deaths (when compared to Western Europe) and, when it did avert deaths, it often did so at substantial cost,” explained Dr. Soneji. “The greatest number of deaths averted occurred in cancers for which decreasing mortality rates were more likely to be the result of successful prevention and screening, rather than advancements in treatment.”

U.S. cancer mortality rates have decreased by 12% since 1970, compared to a 62% decrease for heart disease. Such findings have raised questions about the value of U.S. cancer care derived from additional spending, in comparison to other high-income countries. This study compared U.S. and Western European spending, between 1982 and 2010, for 12 of the most common cancers.

The United States averted 67,000 breast cancer deaths, 265,000 colorectal cancer deaths, and 60,000 prostate cancer deaths between 1982 and 2010. In this study period, the United States experienced 1,120,000 excess lung cancer deaths compared to Western Europe.

The ratio of incremental cost to quality-adjusted life-years saved equaled $402,000 for breast cancer, $110,000 for colorectal cancer, and $1,979,000 for prostate cancer. These amounts exceed most accepted thresholds for cost-effective medical care. The United States lost quality-adjusted life-years despite additional spending for lung cancer, where the cost was −$19,000 per quality-adjusted life-year saved.

Study as Compared to Previous Research

Dr. Soneji reports that his group was unable to replicate the findings of a previous study also published in Health Affairs, and cited on page 167 in the 2013 Economic Report of the President. Dr. Soneji described his new results as “substantially contrary to previous findings, especially for breast and prostate cancer, despite using the same data.” Nonreplicability is a serious problem throughout academia; to avoid such issues, Dr. Soneji makes his data and procedures available in perpetuity to all scholars on an open-access repository called Dataverse.

The focus of Dr. Soneji's next work will be significant for policymakers. He will assess whether greater access to preventive services created by the Affordable Care Act translates to greater use of those types of medical care. If so, health-care reform may lead to more cancer deaths being averted, potentially in a cost-effective manner.

Dr. Soneji is the corresponding author for the Health Affairs article.

This study was supported by the National Institutes of Health, the National Cancer Institute, the National Institute on Aging, and the National Center for Advancing Translational Sciences.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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