While the US spends twice as much on cancer care as the average high-income country, cancer death rates are only slightly better than average, according to a new analysis by researchers from Yale University and Vassar College.
The results were published May 27 in the JAMA Health Forum.
“There is a common belief that the US provides the most advanced cancer care in the world,” said lead author Ryan Chow, an MD/Ph.D. student at Yale. “Our system is being touted for developing new treatments and getting them to patients faster than in other countries. We were curious if the substantial US investment in cancer care is indeed associated with better cancer outcomes.”
Of the 22 high-income countries included in the survey, the United States had the highest spending rate.
“The US spends more than $200 billion a year on cancer care — about $600 per person, compared to the average of $300 per person in other high-income countries,” said senior author Cary Gross, professor of medicine and director of the National Clinician Scholars Program at Yale. “This begs the main question: are we getting value for money?”
The researchers found that national cancer care expenditures showed no correlation with cancer death rates at the population level. “In other words, countries that spend more on cancer care don’t necessarily have better cancer outcomes,” Chow said.
In fact, six countries — Australia, Finland, Iceland, Japan, Korea and Switzerland — had both lower cancer deaths and lower expenditures than the United States.
Smoking is the strongest risk factor for cancer death, and the number of smokers has historically been lower in the United States than in other countries. When the researchers controlled for international variations in smoking rates, cancer death rates in the US did not differ from those in the average high-income country, with nine countries — Australia, Finland, Iceland, Japan, Korea, Luxembourg, Norway, Spain and Switzerland — which has lower smoking-adjusted cancer deaths than the United States.
“Adapting for smoking shows the United States in an even less favorable light, because the low smoking rates in the US were protective against cancer deaths,” Chow said.
More research is needed to identify specific policy interventions that could meaningfully reshape the cancer care system in the United States, the authors say. However, they point to lax regulation of cancer drug approval and drug pricing as two major contributing factors to the high cost of cancer care in the US.
“The pattern of spending more and getting less is well documented in the US health care system; now we’re seeing it in cancer care,” said co-author Elizabeth Bradley, president of Vassar College and professor of science, technology and society. “Other countries and systems have a lot to teach the US if we were open to change.”