High cancer treatment costs in the US – are they worth it? Study explores

By Dr. Ananya Mandal, MDApr 10 2012

Healthcare in the United States is costlier than care in other countries. A new analysis suggests that the cost may be worth it at least when it comes to cancer care.  Americans may pay more for cancer treatment, but they also live longer after diagnosis - getting a benefit that offsets their higher health expenses the study says.

“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 University of Chicago public policy researcher Tomas Philipson and colleagues, in a paper published Monday by the journal Health Affairs.

The team of researchers looked at extensive databases to compare cancer treatment costs and cancer survival data in the U.S. with those in 10 countries that represent 36% of the population of the European Union: Finland, France, Germany, Iceland, Norway, Slovakia, Slovenia and Sweden, as well as Scotland and Wales, which are part of the United Kingdom. 

First they examined the costs — and found that Americans spend much more on cancer care than Europeans, with U.S. spending increasing 49%, from $47,000 per case to $70,000 per case (in 2010 dollars,) between 1983 and 1999.  In the European countries, spending grew 16% over the same period, from $38,000 to $44,000. Then they looked at survival data for patients with types of cancer, including breast, prostate, colorectal and blood cancers, among others.

Comparing length of time from diagnosis to death, as well as differences in survival gains over time, they discovered that among patients diagnosed from 1995 to 1999, average survival in the U.S was 11.1 years and in the European countries studied was 9.3 years. Finally, the team used a standard method to put a “conservative” monetary value on the extra longevity of $150,000 per year.  Taking together all the numbers, they found that the extra years Americans enjoyed amounted to $598 billion worth of benefit over the period studied — about $61,000, on average, per patient.

“Our findings bear on the larger question of whether higher U.S. health care spending is worth it, suggesting - although not confirming - that it is,” the researchers wrote. “Further research is required to examine the drivers of spending and their effects on outcomes, including assessing the relative contributions of treatments, screening, the skill of health care personnel and other factors in improving patient outcomes,” they concluded.

However, Dr. Otis Brawley, the chief medical officer and executive vice president at the American Cancer Society, who was not involved in the study, said that “this paper has a huge fatal flaw in it.” “When you look at survival from time of diagnosis to time of death and you have a screened population that has a lot of diagnoses, you're filling that population with people who don't need treatment and because they are over-diagnosed, they have very long survival,” he added.

These researchers attribute increased survival to the treatment, when it is really over-diagnosis, Brawley said. “So they are looking at a bunch of wasted, unnecessary treatment and then saying it was money well spent,” he said. “You don't look at survival rates - this is a classic misuse of survival rates,” Brawley said. “You have to look at death rates for each disease and not survival rates. The measurement should not be expense versus survival - it should be expense versus mortality rate.”

“We all need to take a step back and take a look at reality and ask whether the patient stands a good chance of benefiting from a particular treatment. If there aren't benefits, then we ought to, perhaps, stop,” he said. “Instead of talking about rationing care, we need to talk about the rational use of care,” Brawley added.