Cancer Care Costs Vary Substantially Among EU Nations

Roxanne Nelson

October 15, 2013

Cancer care is expensive. The 27 countries in the European Union (EU) spend about €126 billion annually. However, spending by country varies considerably, according to a report published online October 14 in the Lancet Oncology.

In 2009, the EU countries with the largest populations — France, Germany, Italy, and the United Kingdom — accounted for two thirds of all costs (€82.9 billion). Bulgaria, Cyprus, Estonia, Latvia, Lithuania, Luxembourg, and Malta had the lowest overall costs. Combined, they accounted for only 1% of total EU expenditures (€1.23 billion).

The main driver of cancer-related healthcare costs is a nation's wealth, explained Ramon Luengo-Fernandez, MA, MSc, DPhil, senior researcher at the Health Economics Research Centre at the University of Oxford, United Kingdom. "In general, wealthier countries tend to spend more, both in absolute and relative terms, on healthcare and subsequently on cancer care," he said.

But there are other reasons for variations in spending by country. "Some countries rely heavily on inpatient services to provide cancer care, while others resort more to the outpatient services, which are, in most cases, considerably less costly," he said in a statement.

"Further research is required to better understand the reasons behind the differences identified in our research," he added.

The cost of cancer care per person was equivalent to €102 in the EU countries, but this cost varied widely between countries. For example, the cost in Luxembourg was €184 and in Bulgaria was €16. The differences in these costs, the authors note, remained after adjustment for price differentials using the purchasing power parity method.

"It is vital that decision-makers across Europe use this information to identify and prioritize key areas," said coauthor Richard Sullivan, MD, PhD, from King's College in London, United Kingdom.

"More effective targeting of investment may prevent healthcare systems from reaching the breaking point — a real danger given the increasing burden of cancer — and in some countries better allocation of funding could even improve survival rates," he said in a statement.

Total Burden of Disease

"Implementation of high-quality cancer care is difficult without a thorough understanding of the total burden of disease and the resources needed to provide appropriate care," writes Gary Lyman, MD, from the Duke University School of Medicine, Durham, North Carolina, in an accompanying comment.

He points out that "robust data" showing a correlation between increased spending and better outcomes remains elusive. A report from the Karolinska Institute suggested that improvements in cancer survival could be partly attributed to access to the newest therapies (Ann Oncol. 2007;18[Suppl 3]:iii1–iii77), whereas other data have shown a strong inverse correlation between per person expenditure and the ratio of cancer mortality and incidence across Europe.

"Several studies have also suggested that cancer survival is more likely in the USA — where more is spent on healthcare per person than in any other nation — than in Europe," Dr. Lyman notes.

"However, the US population overall does not fare well compared with European and other industrialized nations when assessed on the basis of many health outcome measures, including life expectancy. Despite calls for fair pricing of cancer drugs, and continuing healthcare reform efforts, the US Institute of Medicine has concluded that the US healthcare system is fragmented and ill prepared to address existing and future disparities in cancer care," he writes.

Dr. Lyman concludes that challenges remain for the reliable analysis and interpretation of aggregate economic and clinical outcome data, which are required to make "inferences about the variation in expenditure and the comparative value of healthcare interventions across countries."

What are needed right now, he says, are "well-designed clinical trials" that are complemented by "high-quality real-world population data, and clinically relevant modeling studies are needed to answer important questions about the true effect of healthcare expenditures on meaningful clinical outcomes for the global community."

In-patient and Lung Cancer Costs Highest

In their analysis, Dr. Luengo-Fernandez and colleagues evaluated the cost of all cancers and of breast, colorectal, lung, and prostate cancers. They estimated healthcare costs in primary, outpatient, emergency, and inpatient settings, the cost of drugs, the cost of unpaid care provided by relatives or friends, the cost of lost earnings after premature death, and costs associated with individuals who temporarily or permanently left employment because of cancer.

The overall cost of cancer care in the EU was €51.0 billion, which accounted for 4% of total healthcare expenditures, they report.

Inpatient care accounted for 56% of the €51.0 billion (€28.4 billion), and drugs accounted for 26% (€13.5 billion).

Losses related to productivity were estimated to be €42.6 billion for premature death and €9.4 billion for lost working days. The cost of informal care was estimated to be €23.2 billion

All of these costs varied by country — in some cases, quite substantially.

Lung cancer accounted for 15% of overall cancer costs (€18.8 billion), and was responsible for the largest loss in productivity. This was followed by breast cancer, which accounted for 12% (€15.0 billion), colorectal cancer, which accounted for 10% (€13.1 billion), and prostate cancer, which accounted for 7% (€8.43 billion).

This study was funded by an unrestricted education grant from Pfizer. Dr. Sullivan reports receiving financial support from the Umberto Veronesi Foundation. Dr. Lyman has disclosed no relevant financial relationships.

Lancet Oncol. Published online October 14, 2013. Abstract, Comment


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