Delivering affordable cancer care in high-income countries: a Lancet Oncology Commission (original) (raw)
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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.
In high-income countries the public policy consensus is that costs of delivering high-quality equitable cancer care present an increasing challenge to national budgets. In the U.S. alone it is estimated cancer care expenditures in 2020 will be 157 billion dollars. The increase is being driven by a number of factors including technological innovation, rising costs of medical and hospital care, expensive therapeutics and an increase in the proportion of individuals susceptible to malignancy as the population ages. In this article we review what factors are informing and influencing the political debate on cancer economics across Europe and North America.
In high-income countries the public policy consensus is that costs of delivering high-quality equitable cancer care present an increasing challenge to national budgets. In the U.S. alone it is estimated cancer care expenditures in 2020 will be 157 billion dollars. The increase is being driven by a number of factors including technological innovation, rising costs of medical and hospital care, expensive therapeutics and an increase in the proportion of individuals susceptible to malignancy as the population ages. In this article we review what factors are informing and influencing the political debate on cancer economics across Europe and North America.
Media Reporting of Affordable Cancer Care in High Income Countries: a Lancet Oncology Commission
Money and cancer care were always going to be a volatile combination for this Commission (Lancet Oncology 2011 12(10): 923-980). Add in a complex subject, a lack of an educated (on the whole) media as well as strong ideological leanings and critical fusion was soon reached! One of the first phenomena to emerge was the Chinese whisper. In these days of e-media misinformation is rapidly passed on. In this case it started with the Daily Telegraph trumpeting that the conclusions were that we should deny dying patients beneficial treatments. Their strap-line 'Dying cancer patients should not be given 'futile' drugs' was pure fiction, although a lot of the text accompanying it was correct (a sizeable amount though was not). This theme rapidly caught on infecting about 40% of the subsequent e-media. To make matters worse a Daily Telegraph bloggist then repeated and even expanded on the more outlandish and frankly false 'facts'. Remarkably the viral dissemination didn't stop at e-media but managed to jump the 'species' barrier to get into radio. And not just any old radio but the BBC. From main to regional programs the 'story' was the same; doctors want to deny dying cancer patients beneficial treatment. What also emerged, however, from the radio interviews were two other serious issues. The first was an almost complete over-focus on medicines, to the point that many discussants honestly believed that cancer medicines were the key technology in the control and cure of cancer. This wasn't a complete surprise. Some time ago we conducted a study of BBC website reporting of cancer; drug stories were the dominant feature by far (Brit J Cancer 2008, 99: 569-76). What was a surprise was the inability of people to accept that this 'reality' was not true. More broadly there was an almost zero level of understanding of any of the drivers and issues to delivering affordable cancer care. The second issue was more ideological. This came through on both the responses to e-media and the radio interviews. No value can be put on a human life. To put it another way a substantial number (around 40% by my reckoning) said that we should pay for treatment or interventions no matter what the cost nor how little benefit the interventions could potentially give. The reality that nearly everything we do in life is framed within the economics of value of a statistical life was utterly rejected. Moreover the ability to see a societal duty, that these decisions had consequences and impact on other lives was given no importance. Social justice was about 'me'. Returning for a moment to the 'why' behind the almost exclusive focus on cancer medicines it is clear that the professional-industrial-media complex must take full responsibility. Fed on a daily diet of drugs, if you'll excuse the pun, is it any wonder about the huge misperceptions within the general public. Healthcare professionals and research funding organisations haven't done (Cont.
Journal of Cancer Policy, 2014
In high-income countries the public policy consensus is that costs of delivering high-quality equitable cancer care present an increasing challenge to national budgets. In the U.S. alone it is estimated cancer care expenditures in 2020 will be 157 billion dollars. The increase is being driven by a number of factors including technological innovation, rising costs of medical and hospital care, expensive therapeutics and an increase in the proportion of individuals susceptible to malignancy as the population ages. In this article we review what factors are informing and influencing the political debate on cancer economics across Europe and North America.
Can we Continue to Afford Access to Cancer Treatment?
European Oncology & Haematology
Oncology is facing a crisis of affordability that is not sustainable. The economic burden of cancer is growing, as a result of the rising cancer incidence and increased survival, alongside growing investment in disease prevention, diagnosis and treatment. The prices of new cancer drugs continue to increase, placing growing pressure on many healthcare systems. The aim of this article is to explore the reasons why the cost of cancer care is increasing, and why this increase may become unsustainable unless changes are made. There are only limited options for future health spending. Finding ways to improve the allocation of existing resources to achieve the best outcomes for patients will be key to achieving sustainability, whilst safeguarding the continued development of new, effective cancer treatments. Currently, too many cancer drugs are approved without robust evidence of value, and spending more on treatments does not necessarily translate to improvements in health. For all new dr...