US Spends Most on Cancer Care, but Does Not Have Lowest Mortality

Roxanne Nelson, RN, BSN

June 09, 2022

A new analysis shows that the United States spends twice as much on cancer care as the average high-income country, but its cancer mortality rates are only slightly better than average.

"The US is spending over $200 billion per year on cancer care — roughly $600 per person, in comparison to the average of $300 per person across other high-income countries," said senior author Cary Gross, professor of medicine and director of the National Clinician Scholars Program at Yale School of Medicine, New Haven, Connecticut.

However, the analysis found no relationship between the amount spent on cancer care and population-level cancer mortality rates.

"In other words, countries that spend more on cancer care do not necessarily have better cancer outcomes," said lead author Ryan Chow, an MD/PhD student at Yale.

In fact, six countries — Australia, Finland, Iceland, Japan, Korea, and Switzerland — had both lower cancer mortality and lower spending than the US.

The analysis was published online May 27 in JAMA Health Forum.

"There is a common perception that the US offers the most advanced cancer care in the world," Chow commented in a Yale press release.

"Our system is touted for developing new treatments and getting them to patients more quickly than other countries. We were curious whether the substantial US investment on cancer care is indeed associated with better cancer outcomes."

For their study, Chow, Gross, and Elizabeth Bradley, PhD, from Vassar College in Poughkeepsie, New York, conducted a cross-sectional analysis of cancer care expenditures and age-standardized population-level mortality rates among 22 of the 34 high-income countries included in the Organisation for Economic Co-operation and Development (OECD) in 2020.

Media per capita spending for cancer care was $296, but spending in the US was higher than any other country ($584), and was nearly twice the average.

Of 22 countries included in the analysis, the median cancer mortality rate was 91.4 per 100 000 population.

The analysis found that the US cancer mortality rate was higher than that of 6 other countries, at 86.3 deaths per 100,000 people. Korea had the lowest cancer mortality rate, at 75.5 deaths per 100,000. The highest rate was in Denmark at 113.7 deaths per 100,000.

The percentage of healthcare expenditures for cancer care was lowest in Sweden (3.7%) and highest in Korea (9.6%). The median per capita spending ranged from $132 in Spain to $584 in the US. (Currency values are in 2021 US dollars.)

The team then adjusted the analysis to control for international variations in smoking rates. They note that smoking is the strongest risk factor for cancer mortality, and smoking rates have historically been lower in the United States, compared to other countries.

When the analysis was adjusted for smoking, nine countries had lower cancer care expenditures and lower smoking-adjusted cancer mortality rates than the US. The nine countries were Australia, Finland, Iceland, Japan, Korea, Luxembourg, Norway, Spain, and Switzerland.

"Adjusting for smoking shows the United States in an even less favorable light, because the low smoking rates in the US had been protective against cancer mortality," said Chow.

Overall, spending on cancer care was not associated with cancer mortality rates, whether or not the data were adjusted for smoking, the authors note.

More research is needed to identify specific policy interventions that could meaningfully reform the United States cancer care system, the authors say.

Understanding how other countries achieve lower cancer mortality rates at a fraction of the cost could be useful to future researchers, clinicians, and policymakers. They also point to the very high prices of cancer drugs in the US as one factor contributing to the high expenditure. Drug costs in the US are higher than in other countries, as previously reported by Medscape Medical News.

Gross reported receiving grants from the National Comprehensive Cancer Network Foundation (funds provided by AstraZeneca), personal fees from Genentech Research (support for cancer equity research), and grants from Johnson & Johnson (support for developing new models of clinical trial data sharing) outside the submitted work. Chow and Bradley report no relevant financial relationships.

JAMA Health Forum. Published online May 27, 2022. Full text

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