Delivering affordable cancer care in high-income countries

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• 作者：Prof Richard Sullivan ; MD^a ; ^{richard.sullivan@kcl.ac.uk} ; Prof Jeffrey Peppercorn ; MD^b ; Prof Karol Sikora ; FRCP^c ; Prof John Zalcberg ; FRACP^d ; Prof Neal J Meropol ; MD^e ; Eitan Amir ; MBChB^f ; David Khayat ; MD^g ; Prof Peter Boyle ; PhD^h ; Philippe Autier ; PhD^h ; Prof Ian F Tannock ; MD^f ; Tito Fojo ; MDⁱ ; Jim Siderov ; MClinPharm^j ; Steve Williamson ; MRPharmS^k ; Silvia Camporesi ; PhD^l ; Prof J Gordon McVie ; MD^m ; Prof Arnie D Purushotham ; MDⁿ ; Prof Peter Naredi ; MD^o ; Prof Alexander Eggermont ; MD^p ; Prof Murray F Brennan ; MD^q ; Prof Michael L Steinberg ; MD^r ; Prof Mark De Ridder ; MD^s ; Susan A McCloskey ; MD^r ; Prof Dirk Verellen ; PhD^s ; Terence Roberts ; MD^r ; Prof Guy Storme ; MD^s ; Prof Rodney J Hicks ; FRACP^t ; Prof Peter J Ell ; FmedSci^u ; Bradford R Hirsch ; MD^v ; Prof David P Carbone ; MD^w ; Prof Kevin A Schulman ; MD^v ; Paul Catchpole ; PhD^x ; Prof David Taylor ; BSc^y ; Jan Geissler ; PhD^z ; Nancy G Brinker^aa ; Prof David Meltzer ; MD^ab ; Prof David Kerr ; MD^ac ; Prof Matti Aapro ; MD^ad
• 刊名：Lancet Oncology
• 出版年：2011
• 出版时间：September-October, 2011
• 年：2011
• 卷：12
• 期：10
• 页码：933-980
• 全文大小：1K

文摘

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Summary

The burden of cancer is growing, and the disease is becoming a major economic expenditure for all developed countries. In 2008, the worldwide cost of cancer due to premature death and disability (not including direct medical costs) was estimated to be US$895 billion. This is not simply due to an increase in absolute numbers, but also the rate of increase of expenditure on cancer. What are the drivers and solutions to the so-called cancer-cost curve in developed countries? How are we going to afford to deliver high quality and equitable care? Here, expert opinion from health-care professionals, policy makers, and cancer survivors has been gathered to address the barriers and solutions to delivering affordable cancer care. Although many of the drivers and themes are specific to a particular field¡ªeg, the huge development costs for cancer medicines¡ªthere is strong concordance running through each contribution. Several drivers of cost, such as over-use, rapid expansion, and shortening life cycles of cancer technologies (such as medicines and imaging modalities), and the lack of suitable clinical research and integrated health economic studies, have converged with more defensive medical practice, a less informed regulatory system, a lack of evidence-based sociopolitical debate, and a declining degree of fairness for all patients with cancer. Urgent solutions range from re-engineering of the macroeconomic basis of cancer costs (eg, value-based approaches to bend the cost curve and allow cost-saving technologies), greater education of policy makers, and an informed and transparent regulatory system. A radical shift in cancer policy is also required. Political toleration of unfairness in access to affordable cancer treatment is unacceptable. The cancer profession and industry should take responsibility and not accept a substandard evidence base and an ethos of very small benefit at whatever cost; rather, we need delivery of fair prices and real value from new technologies.