An analysis of whether higher health care spending in the United States versus Europe is 'worth it' in the case of cancer

Abstract

The United States spends more on health care than other developed countries, but some argue that US patients do not derive sufficient benefit from this extra spending. We studied whether higher US cancer care costs, compared with those of ten European countries, were "worth it" by looking at the survival differences for cancer patients in these countries compared to the relative costs of cancer care. We found that US cancer patients experienced greater survival gains than their European counterparts; even after considering higher US costs, this investment generated $598 billion of additional value for US patients who were diagnosed with cancer between 1983 and 1999. The value of that additional survival gain was highest for prostate cancer patients ($627 billion) and breast cancer patients ($173 billion). These findings do not appear to have been driven solely by earlier diagnosis. Our study suggests that the higher-cost US system of cancer care delivery may be worth it, although further research is required to determine what specific tools or treatments are driving improved cancer survival in the United States.

Exhibit 1. Trends in Average Survival from Cancer Diagnosis in the United States and 10 European Countries

Source: Authors' calculations using data from SEER, EUROCARE-3, and EUROCARE-4 databases. Note: Results are standardized by age, gender, and cancer site. Includes EU countries for which survival data were consistently available over the analysis period: Finland, France, Germany, Iceland, Norway, Slovakia, Slovenia, Scotland, Sweden, and Wales.

	1983-1985	1986-1988	1989-1991	1992-1994	1995-1999
US	8.45899	9.18165	9.70518	10.2336	11.0568
EU	7.10271	7.5839	7.93917	8.37374	9.25581

Exhibit 2. Aggregate Value of US Survival Gains in Excess of European Survival Gains for US Patients Diagnosed in 1983-1999, by Site

Source: Authors' calculations using data from SEER, EUROCARE-3, and EUROCARE-4 databases. Note: Abbreviations: AML, acute myeloid leukemia; CML chronic myeloid leukemia, NHL, non-Hodgkin lymphoma. Results are standardized by age and gender. Includes EU countries for which survival data were consistently available over the analysis period: Finland, France, Germany, Iceland, Norway, Slovakia, Slovenia, Scotland, Sweden, and Wales.

Cancer Type	Billions of U.S. Dollars (2010)
Corpus uteri	−66.91817655
Colorectal	−45.53241235
Melanoma	−2.501591049
Chronic myeloid leukemia	15.31767163
Acute myeloid leukemia	29.66885236
Breast	173.1234132
Prostate	626.7031053

Exhibit 3. US Survival Benefits, Costs, and Surplus to Average Cancer Patients in Excess of European Countries

Source: Authors' calculations based on data from SEER, EUROCARE-3, EUROCARE-4, OECD, and the Karolinska Institute. Note: Results are standardized by age, gender, and cancer site. Estimates are expressed in 2010 US dollars. The value of a life-year was set at $150,000. Survival gains and costs are discounted at 3% per year to 1999. Costs are converted to 2010$ using the Consumer Price Index. Includes EU countries for which survival data were consistently available over the analysis period: Finland, France, Germany, Iceland, Norway, Slovakia, Slovenia, Scotland, Sweden, and Wales. Data on health expenditures by country from the OECD were geometrically extrapolated for some years when unavailable.

	1983-1985	1986-1988	1989-1991	1992-1994	1995-1999
Benefits	0	64923.8189	102718.63	111766.46	111766.46
Costs	0	14213.05	19188.28	17507.45	14660.57
Surplus	0	50710.7738	83530.347	94259.011	68850.608

Exhibit 4. Country-Level Correlations between Cancer Spending and Average Cancer Survival

Source: Authors' calculations based on data from SEER, EUROCARE-3, EUROCARE-4, OECD, and the Karolinska Institute. Note: Results are standardized by age, gender, and cancer site. Includes EU countries for which survival data were consistently available over the analysis period: Finland, France, Germany, Iceland, Norway, Slovakia, Slovenia, Scotland, Sweden, and Wales. Estimates of the average gain in cancer survival against the change in cancer expenditures were calculated for the period 1995-1999 relative to the period 1983-1985. Data on health expenditures by country from the OECD were geometrically extrapolated for some years when unavailable.