High price of U.S. cancer care fails to improve odds of survival

NEW HAVEN, Conn. — Iconic television character Walter White had to become a meth cook to pay for his lung cancer treatments, but researchers from Yale University suggest he may have been better off moving to another country. Their study finds the high cost of cancer treatment in the United States doesn’t necessarily translate to a better chance of surviving the disease.

In comparison to the average high-income country, the U.S. spends double on cancer care. Despite that expense, American cancer mortality rates are only slightly better than average.

There is a common perception that the U.S. offers the most advanced cancer care in the world,” says lead study author Ryan Chow, an M.D./Ph.D. student at Yale, in a university release. “Our system is touted for developing new treatments and getting them to patients more quickly than other countries. We were curious whether the substantial U.S. investment on cancer care is indeed associated with better cancer outcomes.”

Researchers from both Yale and Vassar College collaborated on this project, which encompassed 22 high-income countries. Among all of those nations, the United States had the highest spending rate.

The U.S. 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,” explains senior study 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?”

Can money really buy a cure for cancer?

According to the research team, national cancer care spending across nations showed no connection to population-level cancer mortality rates.

“In other words, countries that spend more on cancer care do not necessarily have better cancer outcomes,” Chow clarifies.

Notably, six countries spent less money on cancer treatments but had lower cancer mortality rates than the U.S. Those nations were Japan, Australia, Switzerland, Iceland, Finland, and South Korea.

The number one risk factor for cancer mortality is smoking. This is worth mentioning because cigarette smoking rates in the U.S. are down considerably in comparison to many other countries. When study authors controlled for international variations in smoking habits, U.S. cancer mortality rates actually became identical to those of the “average high-income country” — with nine countries (South Korea, Luxembourg, Norway, Spain, Switzerland, Australia, Finland, Iceland, and Japan) showing 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 U.S. had been protective against cancer mortality,” Chow adds.

How can the U.S. cut costs?

An overhaul of the U.S. cancer care system appears to be necessary, but that is a massive endeavor. As far as where to start, study authors say both the lax regulation of cancer drug approvals and drug pricing are two major elements contributing to the exorbitant cost of U.S. cancer care.

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

The findings appear in JAMA Health Forum.

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