Delivering affordable cancer care in high-income countries: a Lancet Oncology Commission (original) (raw)
Journal of Cancer Policy, 2013
While there is increasing attention to cancer among underserved populations globally, recent publications have suggested that discussions often ignore the broad but critical issues and lack due diligence. This communication considers these subjects. We all seek honest governments, recognition of women's and other human rights, protection of minorities, the fostering of education for all, and the rendering of fair justice. Absence of these overwhelms efforts in cancer care. Massive rural-urban migration and the majority of cancer burdens globally occurring among the huge populations of poor Asians are also dominating realities. In-depth understanding of how people actually live must ground our efforts. Weak governments, weak health systems, and widespread corruption adversely impact work to improve cancer outcomes. Some implications of these painful circumstances are first that cancer-specific, top-down approaches may be less suitable and less effective than locally defined efforts sensitive to particular broad issues. Second, that widespread drug availability may be less an economic issue than a social systems issue. Third, patient education about cancer signs and symptoms may be less useful than direct efforts targeting broad human rights issues to give patients real choices to seek care. We suggest that addressing cancer control for underserved populations needs to be more of an exercise in addressing the major societal issues, living noble values, investigating to see things as they really are, and acting from a model of intervention suitable to the broad complex challenges.
Could African and Low- and Middle-Income Countries Contribute Scientifically to Global Cancer Care?
Journal of Global Oncology, 2015
Could African countries, as exemplars of low-and middle-income countries (LMICs), make scientific contributions that would increase the affordability of cancer care globally? After four decades of effort to improve the quality of care, Robert Brook, a distinguished expert on quality, declared in 2010 "The end of the quality improvement movement: long live improving value!" 1 "Value" is broadly defined as outcomes relative to the total costs of care and encompasses effectiveness, cost-effectiveness, efficiency, quality, safety, and quality of life. 1-3 Value is relevant to cancer care in both developed and developing countries. 1 Better value care does not mean inferior care. Economic studies and measures such as cost reduction without regard to the outcomes achieved are dangerous and can lead to false savings and potentially limit effective care. 2,3
Delivering affordable cancer care in high-income countries
The burden of cancer is growing, and the disease is becoming a major economic expenditure for all developed countries. In 2008, the worldwide cost of cancer due to premature death and disability (not including direct medical costs) was estimated to be US$895 billion. This is not simply due to an increase in absolute numbers, but also the rate of increase of expenditure on cancer. What are the drivers and solutions to the so-called cancer-cost curve in developed countries? How are we going to afford to deliver high quality and equitable care? Here, expert opinion from health-care professionals, policy makers, and cancer survivors has been gathered to address the barriers and solutions to delivering affordable cancer care. Although many of the drivers and themes are specific to a particular field—eg, the huge development costs for cancer medicines—there is strong concordance running through each contribution. Several drivers of cost, such as over-use, rapid expansion, and shortening l...
Evidence-informed frameworks for cost-effective cancer prevention and management are essential for delivering equitable outcomes and tackling the growing burden of cancer in all resource settings. Evidence can help address the demand side pressures (ie, pressures exerted by people who need care) faced by economies with high, middle, and low incomes, particularly in the context of transitioning towards (or sustaining) universal health-care coverage. Strong systems, as opposed to technology-based solutions, can drive the development and implementation of evidence informed frameworks for prevention and management of cancer in an equitable and affordable way. For this to succeed, different stakeholders—including national governments, global donors, the commercial sector, and service delivery institutions—must work together to address the growing burden of cancer across economies of low, middle, and high income.
Hyper-expensive new therapies and the prioritisation of R&D
2011
This background paper-produced for the Nuffield Council on Bioethics Forward Look Seminar 2011-provides a summary of the ethical arguments and policy issues which arise in considering very expensive medical treatments and their place within a fixed healthcare budget such as the NHS.
The cost and value of cancer drugs – are new innovations outpacing our ability to pay?
Israel Journal of Health Policy Research, 2016
Cancer drug expenditures have been increasing significantly in countries around the world. A recent paper in the IJHPR provides new knowledge and insights into this global phenomenon by analyzing how it is playing out in an Israeli health plan with over two million members, whose state-of-the-art information systems provide an opportunity to explore these changes in a comprehensive, detailed and reliable manner. There is a wide variation in both the cost-effectiveness and the budget impact of individual drugs. These issues also vary when analyzing drugs in other countries due to differential pricing mechanisms. In addition to drug expenditure, the overall cost of cancer care is increasing, partly due to expenditures on non-pharmacologic treatments and diagnostic testing. With the arrival of new therapies, the future of cancer care is exciting. However, there will be many challenges ahead with regard to the ability to pay for such innovations. In this commentary we discuss the current problems and anticipate the future challenges.
Treatment Is Worth a Lot - But Just How Much
Biomedicine Hub, 2017
More than at any other time in history, science offers enormous potential to transform the prevention, diagnosis and treatment of many diseases. However, patients are urgently awaiting new therapies - and too often not getting them. And researchers and companies also face significant development obstacles as only one in ten drugs entering clinical trials ever makes it over the finish line. This article looks at the issues involved in bringing innovation into healthcare systems from a political and policy level. It takes a close look at Health Technology Assessment (HTA) across Member States, how it is working and, more to the point, how it isn't, and how it often serves to stymie the introduction of new medicines by undermining the European Medicines Agency (EMA). The article argues that the EU could strengthen HTA cooperation via a common framework, and promote higher quality and fairer assessments; while joint work could reduce duplication of efforts, and promote better synerg...