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 Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. Since 2016, the cohort is being expanded by persons aged 40 years and over. The findings of the Rotterdam Study have been presented in over 1500 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy
 ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.

/pdf/the-rotterdam-study-2018-update-on-objectives-design-and-q1c9cvzmxg.pdf

The Rotterdam Study: 2018 update on objectives, design and main results.

Objectives. To evaluate the costs and clinical effects of 16 alternative strategies for cystic fibrosis (CF) carrier screening in the reproductive setting; and to test the sensitivity of the results to assumptions about cost and detection rate, stakeholder perspective, DNA test specificity, chance of nonpaternity, and couples' reproductive plans. Method. Cost-effectiveness analysis. Results. A sequential screening strategy had the lowest cost per CF birth avoided. In this strategy, the first partner was screened with a standard test that identifies 85% of carriers. The second partner was screened with an expanded test if the first partner's screen was positive. This strategy identified 75% of anticipated CF births at a cost of $367,000 each. This figure does not include the lifetime medical costs of caring for a patient with CF, and it assumes that couples who identify a pregnancy at risk will choose to have prenatal diagnosis and termination of affected pregnancies. The cost per CF birth identified is ap...

Carrier screening for cystic fibrosis: costs and clinical outcomes.

Prevention of colorectal cancer by once-only sigmoidoscopy

In this second part of a 2-part series on the global burden of cardiovascular disease, we review the proven, effective approaches to the prevention and treatment of cardiovascular disease. We specifically review the management of acute cardiovascular diseases, including acute coronary syndromes and stroke; the care of cardiovascular disease in the ambulatory setting, including medical strategies for vascular disease, atrial fibrillation, and heart failure; surgical strategies for arterial revascularization, rheumatic and other valvular heart disease, and symptomatic bradyarrhythmia; and approaches to the prevention of cardiovascular disease, including lifestyle factors, blood pressure control, cholesterol-lowering, antithrombotic therapy, and fixed-dose combination therapy. We also discuss cardiovascular disease prevention in diabetes mellitus; digital health interventions; the importance of socioeconomic status and universal health coverage. We review building capacity for conduction cardiovascular intervention through strengthening healthcare systems, priority setting, and the role of cost effectiveness.

Reducing the Global Burden of Cardiovascular Disease, Part 2: Prevention and Treatment of Cardiovascular Disease.

Objective- To compare the costs ofseveral proposed methods of screening for cystic fibrosis. Setting - England and Wales. Methods - The costs of screening carried out at hospital antenatal clinics, general practitioner (GP) antenatal consulta­ tions, GP surgeries, and at work were estimated using data from demonstration projects. Couple screening, stepwise screening, and screening of individuals were considered. Results - Couple screening at antenatal hospital clinics was the least expensive per carrier couple detected, amounting to £35 700 (£142 900 for each potential cystic fibrosis fetus detected). The costs of the reagents (£25 per test) accounted for over 60% of this total. Conclusions- Antenatal screening, in ad­ dition to being the most cost effective method ofscreening, is also medically the screening method of choice as it provides information at the latest time when effect­ ive preventive action can be taken and at a time when all people to be screened are likely to be accessible. If the costs of the reagents could be re­ duced to £5 (still higher than the costs of most diagnostic reagents) the cost for each pregnant carrier couple offered screening would be reduced by 50% to about £18 000, and the cost ofoffering screening to 684 000 pregnant couples in England and Wales would be about~m instead of £19m. (Joumal of Medical Screening1995;2:22-27)

https://journals.sagepub.com/doi/pdf/10.1177/096914139500200107

Cost comparison of different methods of screening for cystic fibrosis

The primary prevention of cardiovascular disease is a public health priority. To assess the costs and benefits of a Polypill Prevention Programme using a daily 4-component polypill from age 50 in the UK, we determined the life years gained without a first myocardial infarction (MI) or stroke, together with the total service cost (or saving) and the net cost (or saving) per year of life gained without a first MI or stroke. This was estimated on the basis of a 50 % uptake and a previously published 83 % treatment adherence. The total years of life gained without a first MI or stroke in a mature programme is 990,000 each year in the UK. If the cost of the Polypill Prevention Programme were £1 per person per day, the total cost would be £4.76 bn and, given the savings (at 2014 prices) of £2.65 bn arising from the disease prevented, there would be a net cost of £2.11 bn representing a net cost per year of life gained without a first MI or stroke of £2120. The results are robust to sensitivity analyses. A national Polypill Prevention Programme would have a substantial effect in preventing MIs and strokes and be cost-effective.

/pdf/cost-benefit-analysis-of-the-polypill-in-the-primary-3o6ho8pqnk.pdf

Cost–benefit analysis of the polypill in the primary prevention of myocardial infarction and stroke

How much can the nhs afford to spend to save a life or avoid a severe disability

https://journals.sagepub.com/doi/pdf/10.1258/jms.2010.010136

Peter M. Oppenheimer

Papers

Cost comparison of different methods of screening for cystic fibrosis

Cost–benefit analysis of the polypill in the primary prevention of myocardial infarction and stroke

How much can the nhs afford to spend to save a life or avoid a severe disability

Discounting the value of life.

Breast cancer screening