Cancer Care Costs and Outcome

The US undoubtedly spends a higher percent of its GDP on health care than other developed nations do.  But we are a more free-market economy than most of those countries so this spending to a large extent reflects consumer, voter and citizen choices.  Whether we get value for the extra spending is another question, and by many measures we may not.  In one disease class, however, it looks like the high spending may be beneficial.  A study in Health Affairs studies the relationship between a country’s spending on cancer care and mortality outcomes.  (HA Article)   Two mortality measures were used, one for “amenable” mortality, i.e., that that could be avoided by timely treatment, and one for excess mortality, or mortality corrected for non-cancer causes of death.  Sixteen developed countries were studied, basically the US, Japan and most European nations.  The researchers looked both at the absolute level of cancer spending and the rate of increase between 1995 and 2007.  Countries were basically divided into low, medium and high cancer care spending buckets.  All groupings showed some decline in amenable cancer mortality over the study period, but high spending nations had the lowest mortality, followed closely by medium spending ones, with low spenders lagging.  For example, in 2007 there were around 48 deaths per 100,000 population from amenable cancer mortality in high spending countries, compared to 61 in low spending ones.  Excess mortality measures showed even stronger separation, from 167 per 100,000 in the high spending group to 192 in the low spending set.  Furthermore, the countries with the highest rate of cancer treatment spending growth showed the most rapid decline in both amenable and excess cancer mortality.  While interpreting and understanding the implications of the study is complex, the research supports the notion that at least in some cases, more spending can lead to better outcomes.  Regardless of cost, a patient with cancer would likely rather be alive than dead.