https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)33326-3.pdf

Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736%2814%2962038-9.pdf

Global surveillance of cancer survival 1995–2009: analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2)

http://repositorio.inger.gob.mx/jspui/bitstream/20.500.12100/17171/1/PIIS0140673614613477.pdf

The burden of disease in older people and implications for health policy and practice

In the United States, approximately 14 million people have had cancer and more than 1.6 million new cases are diagnosed each year. However, more than a decade after the Institute of Medicine (IOM) first studied the quality of cancer care, the barriers to achieving excellent care for all cancer patients remain daunting. Care often is not patient-centered, many patients do not receive palliative care to manage their symptoms and side effects from treatment, and decisions about care often are not based on the latest scientific evidence. The cost of cancer care also is rising faster than many sectors of medicine--having increased to $125 billion in 2010 from $72 billion in 2004--and is projected to reach $173 billion by 2020. Rising costs are making cancer care less affordable for patients and their families and are creating disparities in patients' access to high-quality cancer care. There also are growing shortages of health professionals skilled in providing cancer care, and the number of adults age 65 and older--the group most susceptible to cancer--is expected to double by 2030, contributing to a 45 percent increase in the number of people developing cancer. The current care delivery system is poorly prepared to address the care needs of this population, which are complex due to altered physiology, functional and cognitive impairment, multiple coexisting diseases, increased side effects from treatment, and greater need for social support. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis presents a conceptual framework for improving the quality of cancer care. This study proposes improvements to six interconnected components of care: (1) engaged patients; (2) an adequately staffed, trained, and coordinated workforce; (3) evidence-based care; (4) learning health care information technology (IT); (5) translation of evidence into clinical practice, quality measurement and performance improvement; and (6) accessible and affordable care. This report recommends changes across the board in these areas to improve the quality of care. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis provides information for cancer care teams, patients and their families, researchers, quality metrics developers, and payers, as well as HHS, other federal agencies, and industry to reevaluate their current roles and responsibilities in cancer care and work together to develop a higher quality care delivery system. By working toward this shared goal, the cancer care community can improve the quality of life and outcomes for people facing a cancer diagnosis.

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Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis

Summary Background In 2008, 2·45 million people were diagnosed with cancer and 1·23 million died because of cancer in the 27 countries of the European Union (EU). We aimed to estimate the economic burden of cancer in the EU. Methods In a population-based cost analysis, we evaluated the cost of all cancers and also those associated with breast, colorectal, lung, and prostate cancers. We obtained country-specific aggregate data for morbidity, mortality, and health-care resource use from international and national sources. We estimated health-care costs from expenditure on care in the primary, outpatient, emergency, and inpatient settings, and also drugs. Additionally, we estimated the costs of unpaid care provided by relatives or friends of patients (ie, informal care), lost earnings after premature death, and costs associated with individuals who temporarily or permanently left employment because of illness. Findings Cancer cost the EU €126 billion in 2009, with health care accounting for €51·0 billion (40%). Across the EU, the health-care costs of cancer were equivalent to €102 per citizen, but varied substantially from €16 per person in Bulgaria to €184 per person in Luxembourg. Productivity losses because of early death cost €42·6 billion and lost working days €9·43 billion. Informal care cost €23·2 billion. Lung cancer had the highest economic cost (€18·8 billion, 15% of overall cancer costs), followed by breast cancer (€15·0 billion, 12%), colorectal cancer (€13·1 billion, 10%), and prostate cancer (€8·43 billion, 7%). Interpretation Our results show wide differences between countries, the reasons for which need further investigation. These data contribute to public health and policy intelligence, which is required to deliver affordable cancer care systems and inform effective public research funds allocation. Funding Pfizer.

Economic burden of cancer across the European Union: a population-based cost analysis

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-eg, the huge development costs for cancer medicines-there 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.

https://www.thelancet.com/pdfs/journals/lanonc/PIIS1470204511701413.pdf

Delivering affordable cancer care in high-income countries

The National Institute for Health and Care Excellence (NICE) plays a vitally important role in ensuring patients get timely access to new medicines that are clinically and cost effective. The methods used by NICE to appraise medicines (and other health technologies) [1] are currently undergoing extensive review. As noted by Boysen and Watson [2], this was an important commitment agreed to in the 2019 Voluntary Scheme for Branded Medicines Pricing and Access [3]. The review is arguably the most important examination of NICE’s methods in its 20-year history, because the types of new medicines in the pharmaceutical industry pipeline are very different to those seen previously. Advances in science mean we have new medicines for previously untreatable diseases, often very specific to a small sub-set of patients. Medicines are being developed to treat patients earlier on in the disease pathway, with novel mechanisms of action that in some cases are potentially curative [4–7]. There are significant developments in areas like gene-editing technology, stem cell treatments, exosomes and chimeric antigen receptor T-cell therapies [8]. As these medicines come to the market, health technology assessment (HTA) methods need to evolve to ensure their value is comprehensively captured. NICE’s methods review provides a timely opportunity to make the changes needed, so that patients can access the latest treatments. 2 Key Areas for Focus

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Keeping Pace with Pharmaceutical Innovation: The Importance of the NICE Methods Review.

Collins and Latimer recently estimated the effect on the NHS of the supplementary advice on life extending end of life treatments introduced by the National Institute for Health and Care (formerly Clinical) Excellence (NICE) in 2009.1 2 Their study shows how NICE’s cost effectiveness threshold should work in …

https://www.bmj.com/content/bmj/346/bmj.f3249.full.pdf

Paul Catchpole

Papers

Delivering affordable cancer care in high-income countries

Keeping Pace with Pharmaceutical Innovation: The Importance of the NICE Methods Review.

Analysis of the impact of extending end of life treatments should be treated with caution.