Cancer Care Costs Higher in U.S. Than Europe, But Survival Longer - MedicineNet
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
Health Affairs.
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 1999.
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 said.
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 findings indicated.
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,
Brawley said.
"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.
