Global comparison of cancer outcomes: standardization and correlation with healthcare expenditures

Abstract

Background: Cancer outcomes vary widely among different countries. However, comparisons of cost-effectiveness and cost-efficiency of different systems are complex because the incidences of different cancers vary across countries and their chances of cure also differ substantially. We aim to propose a new standardized method for global comparison and to explore its relationship with economic indicators.

Methods: Cancer statistics from all 184 countries and 27 cancers listed in GLOBOCAN 2012 were analyzed. The complement of age-standardized mortality/incidence ratio [1 - (ASM/ASI)] was taken as the proxy relative survival (RS). Accounting for various country-specific cancer patterns, the cancer site-standardized proxy RS (proxy SS-RS) of individual countries were calculated by weighting the proportion of specific cancer sites as compared with the global pattern of incidence. Economic indicators of different countries listed by the World Bank were correlated with corresponding proxy SS-RS.

Results: Substantial variation in site-specific survival and new case distribution supported the use of proxy SS-RS, which ranged from 0.124 to 0.622 (median 0.359). The median total health expenditure per capita (HEpc) increased from US$44 for countries with proxy SS-RS < 0.25, to US$4643 for countries with proxy SS-RS ≥0.55. Results from logarithmic regression model showed exponential increase in total HEpc for better outcome. The expenditure varied widely among different strata, with the widest difference observed among countries with SS-RS ≥0.55 (total HEpc US$1412-$9361).

Conclusions: Similar to age-standardization, cancer site-standardization adjusted for variation in pattern of cancer incidence provides the best available and feasible strategies for comparing cancer survivals across countries globally. Furthermore, cancer outcome correlated significantly with economic indicators and the amount of HEpc escalated exponentially. Our findings call for more in-depth studies applying cancer-site standardization to provide essential data for sharing of experience and urgent actions by policy makers to develop comprehensive and financially sustainable cancer plan for greater equity.

Keywords: Cancer outcomes; Cancer site-standardized relative survival; Global health; Health economics.

Fig. 1

a Proxy relative survival (RS) / b cancer site-standardized proxy RS by countries (GLOBOCAN 2012)

Fig. 2

Distribution of new cancer cases by country profiles (GLOBOCAN 2012). The cancers were ordered in descending proxy relative survival (RS). Note: Parentheses after categories present the median proxy RS among the countries attributed in that corresponding categories

Fig. 3

Site-standardized proxy relative survival (proxy SS-RS) by country profiles. Values in parentheses indicate (i) the proportion of the incidence among all new cancer cases (except non-melanoma skin cancer for each cancer site) and (ii) the number of countries in each subcategory. The bars represented the median proxy SS-RS and the strokes represented the corresponding minimum and maximum proxy SS-RS among the countries within each subcategory

Fig. 4

Cancer site-standardized proxy relative survival (proxy SS-RS) against economic indicators. a gross national income per capita, GNIpc; b gross domestic product per capita, GDPpc; c total health expenditure per capita, total HEpc; and d public health expenditure per capita, public HEpc