High cost of US cancer care doesn’t lower death rates

"The US is spending over $200 billion per year on cancer care—roughly $600 per person, in comparison to the average of $300 per person across other high-income countries," says Cary Gross. (Credit: Getty Images)

The United States spends twice as much on cancer care as the average high-income country, but its cancer mortality rates are only slightly better than average, according to a new analysis.

“There is a common perception that the US offers the most advanced cancer care in the world,” says lead author Ryan Chow, an MD/PhD student at Yale University.

“Our system is touted for developing new treatments and getting them to patients more quickly than other countries. We were curious whether the substantial US investment on cancer care is indeed associated with better cancer outcomes.”

Out of the 22 high-income countries included in the study, the United States had the highest spending rate.

“The US is spending over $200 billion per year on cancer care—roughly $600 per person, in comparison to the average of $300 per person across other high-income countries,” says senior author Cary Gross, professor of medicine and director of the National Clinician Scholars Program at Yale. “This raises the key question: Are we getting our money’s worth?”

The researchers found that national cancer care spending showed no relationship to population-level cancer mortality rates. “In other words, countries that spend more on cancer care do not necessarily have better cancer outcomes,” says Chow.

In fact, six countries—Australia, Finland, Iceland, Japan, Korea, and Switzerland—had both lower cancer mortality and lower spending than the United States.

Smoking is the strongest risk factor for cancer mortality, and smoking rates have historically been lower in the United States, compared to other countries. When the researchers controlled for international variations in smoking rates, US cancer mortality rates became no different than the average high-income country, with nine countries—Australia, Finland, Iceland, Japan, Korea, Luxembourg, Norway, Spain, and Switzerland—having lower smoking-adjusted cancer mortality than the United States.

“Adjusting for smoking shows the United States in an even less favorable light, because the low smoking rates in the US had been protective against cancer mortality,” says Chow.

More research is needed to identify specific policy interventions that could meaningfully reform the United States cancer care system, the authors say. However, they point to lax regulation of cancer drug approvals and drug pricing as two key factors contributing to the high cost of US cancer care.

“The pattern of spending more and getting less is well-documented in the US health care system; now we see it in cancer care, too,” says coauthor Elizabeth Bradley, president of Vassar College and professor of science, technology, and society. “Other countries and systems have much to teach the US if we could be open to change.”

The study appears in JAMA Health Forum.

Source: Yale University