Cancer Care Spending in the US May Not Be Proportionate With Better Cancer Outcomes

Results from a recent cross-sectional study of national cancer care expenditures and cancer mortality rates across 22 high high-income countries indicate that although the US spent twice as much on cancer care as the median country, the cancer mortality rate in the US was comparable to that of a median high- income country. Thus, the findings of this study suggest that the US expenditure on cancer care may not be commensurate with enhanced cancer outcomes (JAMA Health Forum. 2022; 3(5):e221229. 2022. doi:10.1001/jamahealthforum.2022.1229).

Ryan D Chow (MD-PhD Program, Yale School of Medicine, New Haven, CT) and colleagues sought to evaluate whether cancer mortality rates in 2020 were lower in countries with higher cancer-related spending, and to estimate across countries the incremental cost per averted cancer death.

The cross-sectional, national-level analysis was conducted from September 1, 2021, to March 31, 2022, and involved 22 high-income countries. Researchers evaluated the correlation between cancer care expenditures and age-standardized population-level cancer mortality rates in 2020 with and without adjustment for smoking.

The primary outcomes and measures were age-standardized population-level cancer mortality rates.

Average cancer mortality rate was 91.4 per 100,000 population (IQR, 84.2-101.6) and the US cancer mortality rate was greater than that of 6 other countries (86.3 per 100,000). Average per capita spending in USD for cancer care was $296 (IQR, $222-$348), with the US spending more than any other country ($584). After adjusting for smoking, nine countries had lower cancer care expenditures and lower mortality rates than the US. Of the remaining 12 countries, the US additionally spent more than $5 million per averted death relative to four countries, and between $1 and $5 million per averted death relative to eight countries. Cancer care expenditures were not associated with cancer mortality rates, with or without adjustment for smoking (Pearson R = -0.05 [95% CI, -0.46 to 0.38]; P = .81; and R = -0.05 [95% CI, -0.46 to 0.38]; P = .82).   

“In this cross-sectional study of 22 high-income countries, cancer care spending was not associated with age-standardized cancer mortality rates. Although the US spent more on cancer care than any other country, this expenditure was not associated with substantially lower cancer mortality rates. Understanding how other countries achieve lower cancer mortality rates at a fraction of US spending may prove useful to future researchers, clinicians, and policy makers seeking to best serve their populations,” concluded the authors.