The Economics of Improved Cancer Survival Rates: Better Outcomes, Higher Costs

Carin A Uyl-de Groot; Saskia de Groot; Adri Steenhoek

Disclosures

Expert Rev Pharmacoeconomics Outcomes Res. 2010;10(3):283-292. 

In This Article

Background

Approximately 3,191,600 new cancer cases were diagnosed in Europe in 2006. The same year, approximately 1,703,000 individuals died from cancer. The most common types of cancer were breast (13.5%), colorectal (12.9%) and lung cancer (12.1%), and the most common causes of death from cancer were lung cancer (19.7%), colorectal cancer (12.2%) and breast cancer (7.7%).[1] The incidence of cancer is increasing owing to an aging population and population growth. Simultaneously, survival rates have been improving due to advances in diagnosis and treatment.[2] Growing knowledge regarding cancer biology and advancements in technology have resulted in new diagnostics and treatments being developed.[3] In particular, developments in imaging and other diagnostic techniques have contributed substantially to an increased probability of diagnosis and to the more accurate diagnoses of cancer.[101] Since the 1970s, new diagnostic tools such as computerized tomographic (CT) scans, MRI and positron emission tomography (PET), sometimes in combination with CT (PET/CT), have greatly improved diagnostic accuracy.[102] These technologies are not solely used for diagnosis, they are also used for cancer screening and to evaluate patients' responses to treatment. Early diagnosis as a result of screening has been demonstrated to be of potential benefit in several cancers. In this respect, screening is the application of a simple test to identify early, asymptomatic disease.[4] It is claimed that the early detection of cancer through screening based on imaging is probably the major contributor to the reduction in mortality for certain cancers.[5]

There have also been major developments in the treatment of cancer. The first cancer drugs were discovered in the 1940s and during 1950–1980, new agents were developed. The use of platinum compounds was one of the first breakthroughs. During the 1980s, the situation was quite stable and anthracyclines were one of the most efficient drugs. From 1990 onwards, several new agents were developed and these agents are more targeted at disease-specific mechanisms (e.g., taxoids [paclitaxel and docetaxel], gemcitabine and irinotecan) than the older agents were. However, it is debatable whether or not the costs exceed the reported benefits of many new drugs. Several of these drugs report prolongation of survival by 1 or 2 months, sometimes against the expense of more toxicity. In that respect, the question of 'what is the quality of life of these extra months' becomes relevant.[6]

Developments in molecular medicine have contributed to a better understanding of cancer. Molecular medicines target the disease where it is caused – at the level of the gene or the gene product in the critical cell. It enables not only the earlier and more precise detection of diseases and even predisposition, but also personalized treatments that are more effective, cause less toxicity and are hopefully more cost effective owing to the stratification of specific patient risks and the prediction of response to treatment.

This article discusses the improved cancer survival rates and the associated costs. Three cancer types will be described in detail: breast cancer, colorectal cancer and lung cancer. These types of cancer have the highest incidences combined with the highest economic burden. The Netherlands will be highlighted several times as more detailed information, especially cost data, were available for this country. We used data from the Organization for Economic Co-operation and Development (OECD) Health Data and the Dutch cancer registry extensively for this review. In addition, a literature search was conducted through the PubMed database for recent publications related to cancer, breast cancer, colorectal cancer, lung cancer, costs, burden, incidence, mortality or survival.

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