Cancer Care Costs Higher in U.S. Than Europe, But
MONDAY, April 9 (HealthDay News) -- The United States spends
more on health care than any other country, but those high costs
may be paying off in cancer survival, a new report suggests.
U.S. cancer patients often live almost two years longer than
similar patients in Europe, arguing for the dollar value of care
given, researchers say.
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."
On that scale, the United States does well for some cancers and
as well as they do in most of Europe for others, he said.
"Mortality rates for breast and colon cancer are close to the
mortality rates in Europe, but that may include the effect of
over-treatment," Brawley said.
The report was published in the April issue of
For the study, Tomas Philipson, the chair in public policy at
the University of Chicago, and colleagues looked at cancer care in
the United States and in 10 European countries from 1983 to
The investigators found that for most cancers, U.S. patients
lived longer than Europeans. Americans lived an average of 11.1
years after diagnosis, compared with 9.3 years for Europeans, they
When the authors translated survival data to dollars, they found
those extra years were worth $598 billion, which is an average of
$61,000 per cancer patient.
The value of these survival gains was highest for prostate
cancer ($627 billion) and breast cancer ($173 billion), the
To put a monetary value on survival, the researchers used a
"statistical-life concept." In many such studies, they said,
estimates are based on how much income a person would exchange for
a lower risk of mortality.
"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.
On the larger issue of the costs of cancer treatment, Brawley
said that "we spend money in an irrational way. We harm people by
over-treating them and over-treatment costs money."
Many patients are getting treatments that cause harm, but don't
really prolong life, Brawley said. It's hard for a doctor to tell a
patient there is nothing that can be done.
"That is the kind of thing doctors need to be developing skills in -- it's an emotional hurdle to say 'I can't stop this,'" he said.
Many patients think that giving up is admitting defeat, and want
to be treated even if the treatment will do more harm than good,
"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.
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