Compared with other high-income nations, the United States' cancer mortality rates are only slightly better than average despite spending twice as much on care, according to a new study published in JAMA Health Forum.

Study details and key findings

For the cross-sectional study, researchers from Yale University and Vassar College analyzed the association between cancer care costs and cancer mortality rates in 22 high-income countries in 2020. The study was conducted between Sept. 1, 2021, and March 31, 2022.

Based on the analysis, the median per capita spending for cancer care in all 22 countries was $296. In comparison, the United States had a median per capita spending of $584, higher than any other country in the analysis. The countries with the lowest median per capita spending were Spain ($132), Finland ($179), and Italy ($195).

"The U.S. is spending over $200 billion per year on cancer care—roughly $600 per person, in comparison to the average of $300 per person across other high-income countries," said Cary Gross, the study's senior author, a professor of medicine, and the director of the National Clinical Scholars Program at Yale. "This raises the key question: Are we getting our money's worth?"

The median cancer mortality rate for all 22 countries was 91.4 deaths per 100,000 people. The United States had a slightly lower mortality rate at 86.3 deaths per 100,000 people. In total, six countries, Australia, Finland, Japan, Korea, and Switzerland had lower cancer mortality rates than the United States. After adjusting for smoking rates, an additional three countries, Luxembourg, Norway, and Spain, also had lower mortality rates, even though smoking rates have historically been lower in the United States.

Overall, there was no association between a country's cancer care costs and its cancer mortality rates. In fact, the researchers noted that the United States spent more than $1 million per averted cancer death compared with other countries that had higher cancer mortality rates.

Commentary

According to the researchers, several factors contribute to the high cost of cancer care in the United State, relative to its mortality benefits for patients.

"Cancer drug expenditures account for 37% of privately insured U.S. cancer expenditures, and U.S. cancer drug costs are greater than those of other countries," the researchers wrote. "Prices for the same medications are higher in the U.S., and cancer drugs frequently increase in price after their initial launch. This phenomenon stems from the inability of Medicare to negotiate pricing, along with state laws mandating insurers to cover all approved cancer drugs regardless of cost."

In addition, they noted that some of the expensive new cancer treatments used in the United States "often confer marginal or unclear survival gains" for patients. End-of-life cancer care is also resource-intensive and expensive, further adding to U.S. patients' costs.

Currently, more research is needed to identify specific policies that could meaningfully improve the U.S. cancer care system, and the researchers noted that "[u]nderstanding how other countries achieve lower cancer mortality rates at a fraction of U.S. spending may prove useful[.]"

"The pattern of spending more and getting less is well-documented in the U.S. healthcare system; now we see it in cancer care, too," said Elizabeth Bradley, one of the study's authors and the president of Vassar College. "Other countries and systems have much to teach the U.S. if we could be open to change." (Bassett, MedPage Today, 5/31; Gleeson, Becker's Hospital Review, 5/31; Collins, Yale Cancer Center, 5/27; Chow et al., JAMA Health Forum, 5/27)