Prostate Cancer Debate 2014, Rome, Italy
Impact of the cost of cancer care on Europe
Prof Richard Sullivan - King's College London, London, UK
Europe is facing a huge economic burden from cancer over the next decade and research that we published last year in the Lancet Oncology estimated that we now spend across Europe nearly €130 million a year in the economic impact of cancer. This is broadly divided into direct healthcare costs which account for about a third of expenditure; informal care costs which are about, actually, nearly a quarter of expenditure across Europe but also to balance out against that we also have productivity losses. That means premature mortality and morbidity, that’s disability and death before the end of an economically viable life. So, cancer really has a huge impact in terms of the economic burden in Europe. To put it into some perspective, it’s about the equivalent of the amount of money we were spending on the Iraq and Afghanistan wars combined at their height. So this is a major area in terms of delivering affordable cancer care for Europe.
One of the issues around the economic burden for cancer across Europe is to understand what the drivers are. Clearly one of the biggest drivers is the change in demography, the population is rapidly aging in most countries. Central and Eastern European countries will see nearly 65% of their population over the age of 65 by 2035 and that’s a pattern we’re seeing replicated across Europe as fertility rates go down and people live longer. So the demographic factors are really extremely important. The second big driver is just the change in the macro-economic scene across Europe. This is a result of the economic crisis and the lessening ability of healthcare systems to afford cancer care and their care systems in general. The third major driver is around increasingly expensive technologies and particularly in cancer medicines, radiotherapy, new surgical procedures. Whilst these are adding benefits to patients’ outcome they’re all coming with increased price tags and this is all putting a major strain on the individual healthcare systems.
One of the things we’ve done at the Institute of Cancer Policy is really go into depth in terms of the economic burden to understand by individual site area, lung, prostate, etc. what the true economic burden is. For example, in prostate cancer we see a huge variation in the direct healthcare costs being spent per instance case of prostate cancer across Europe from €6,000 all the way through to nearly €34,000 a year. Worryingly, the expenditures don’t really correlate with outcomes, in other words there’s no direct relationship in the sense of putting more money into the system you get better outcomes. This is an important point for policy makers because it’s not simply spending more money here, this is about professional organisations, the cultures of care, the stage at which people are presenting into a healthcare system and also the relative amounts of money we’re spending in individual areas, like medicines, proportional to their benefits. So these are complex adaptive systems in terms of outcomes that need to be addressed even in prostate cancer.
