HA: Is the U.S. getting the most bang for its cancer care buck?

The U.S., as has been well documented, spends more on healthcare than other developed nations, with some arguing that patients aren’t getting their money’s worth. When it comes to cancer care, however, U.S. cancer patients experience greater survival gains than their European counterparts, even when factoring in higher costs, according to a study published in the April issue of Health Affairs. Some experts, though, have criticized the research as misleading.

The analysis of cancer registries and spending data, conducted by Tomas Philipson, PhD, of the University of Chicago, and colleagues, found that investments in cancer care generated $598 billion of additional value for U.S. patients diagnosed with cancer between 1983 and 1999.

“We found that the value of the survival gains greatly outweighed the costs, which suggests that the costs of cancer care were indeed ‘worth it,’” wrote the authors.

Findings were based on data from large cancer registries, such as the Surveillance, Epidemiology, and End Results (SEER) database in the U.S. and the EUROCARE databases in Europe. Life expectancy trends were tracked in the U.S. and a representative group of 10 European countries, with the social value of extra years of survival calculated using conventional statistical values. If the value of these survival benefits outweighed the higher costs of care, the authors considered that supportive of their hypothesis that higher U.S. cancer spending is worth the cost.

When looking at survival alone, the U.S. exceeded the European countries in survival gains after diagnosis from 1983 through 1999, with the greatest disparity existing in prostate cancer, chronic myeloid leukemia and acute myeloid leukemia. In these cancer cases, U.S. patients gained an additional two years of survival compared with their European counterparts.

Over the same period, U.S. spending on cancer care per cancer case increased 49 percent, while spending in the 10 European countries increased 16 percent. In 1999, the U.S. spent $70,000 per cancer case compared with Europe’s $44,000 per cancer case.

The last part of the equation is the value of a statistical life. This concept attempts to capture the value of reducing the risk of mortality, and factors in income that would be given up in exchange for lower risk of mortality, according to the authors. A statistical life is worth between $5 million and $12 million, and Philipson et al elected to base their conclusions on the conservative calculation of $150,000 per statistical life-year.

The sum of all of the factors equated to $598 billion in overall added value for U.S. cancer patients even after subtracting the difference in cost of care. Benefits were greatest for U.S. prostate cancer patients, who realized $627 billion in added value, and breast cancer patients, who realized $173 billion.

“Compared with the U.S., European countries typically treated prostate cancer less aggressively, with lower use of these technologies during this time period,” wrote the authors. “In addition, new cancer drugs often reach U.S. patients sooner than their European counterparts, in part because of delays or denials of reimbursement decisions within Europe.”

The U.S. did not generate more additional value in every cancer type. European survival gains were higher for uterine cancer, colorectal cancer and melanoma, resulting in $67 billion, $46 billion and $2.5 billion in excess European gains, respectively.

Not everyone is buying the conclusions of Philipson et al. A Reuters report quoted two healthcare experts who said the study is flawed due to lead-time bias, an issue when tracking survival gains, and doesn’t account for overdiagnosis. Don Berry, PhD, of MD Anderson Cancer Center in Houston, called the study “pure folly,” “misguided” and “dangerous.”

H. Gilbert Welch, MD, MPH, of the Dartmouth Institute for Health Policy & Clinical Practice in Hanover, N.H., pointed out that the two types of cancers in the study demonstrating the most return on investment, prostate cancer and breast cancer, are the two cancers with the most serious lead-time bias and overdiagnosis issues due to screening, according to Reuters.

The European countries included in the analysis were Finland, France, Germany, Iceland, Norway, Slovakia, Slovenia, Scotland, Sweden and Wales.

While concluding that higher U.S. healthcare spending is worth it, at least when it comes to cancer care, Philipson and colleagues acknowledged that further research is needed to examine the drivers of spending and the factors that result in improved patient outcomes.