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

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


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

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Expert Commentary

The global cancer burden will increase over time. There are several indications that support this hypothesis: the world's population is increasing and aging of the population will further lead to an increase in cancer burden. An underlying rise in the incidence rates could increase the future cancer burden, even if the population size remains constant and the age distribution remains stable.[101] Furthermore, survival rates for most cancers have improved as a consequence of new tools for diagnosis, treatment and follow-up. Decreasing mortality rates are reported in breast cancer, colorectal cancer and lung cancer in males. Despite the increase in survival rates, large between-country differences in survival are present. This is particularly the case for breast cancer, with survival rates varying from 61.6 to 90.5%.

Simultaneously, cancer costs are increasing in Europe and this trend will proceed in the coming years, although probably not at the same speed as in past years. An indication for a slower cost increase is that the patents for new drugs that were introduced in recent years will expire and generic versions will enter the market.[102] Moreover, growing knowledge about predictive and prognostic factors will result in more tailored therapies in the future and this could potentially save costs. Whether the increasing costs are acceptable to society or not is not only an economic question, but also has a moral dimension: the question, what counts as benefits becomes more important? Not only should improvements in survival be taken into account, but also the quality of life of this prolonged survival.

Cost and cost-effectiveness considerations have gained importance over the past decade. The resulting outcomes of economic evaluations are of increasing significance in policy decisions and for regulatory agencies. The decision as to whether or not a new therapy will be reimbursed will be influenced by the results of such evaluations.[19] In many advanced cancers, alternative treatment options are clearly less effective, the severity of the disease is quite high and the prognosis of the patient is poor, especially in grade III and IV patients. It is quite difficult to achieve significant gains in survival and/or progression-free survival. This implies that in most cancers, cost–effectiveness ratios are higher than commoly used thresholds, but the ratios are still accepted. Nevertheless, thresholds are necessary to avoid prices of tests and drugs becoming too high and incentives for the industry to lower prices do not exist.[20]

To keep healthcare affordable, to ensure access and to provide high-quality care to all patients, policymakers should take into account several aspects when deciding on the reimbursement of new therapies. Improvements should be clinically meaningful and the introduction of the new drug should be affordable in economic terms. New genetic tests and biomarkers may help to identify subtypes of patients who will respond to new cancer drugs. By restricting the use of new drugs to those patients that have a greater likelihood of benefiting from them, a major cost reduction could be achieved.[20]

In any case, with the new agents, genetic tests and biomarkers on the horizon, it is clear that an unrestricted reimbursement policy is not an option. In our opinion, there is much to gain in cancer diagnosis and treatment, but it should be worth the costs.