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      Comparison of Cancer-Related Spending and Mortality Rates in the US vs 21 High-Income Countries

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      , PhD 1 , , PhD 2 , , MD 3 , 4 ,
      JAMA Health Forum
      American Medical Association

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          Key Points

          Question

          Is spending on cancer care associated with lower cancer mortality rates?

          Findings

          In this cross-sectional study of 22 high-income countries, national cancer care expenditures in 2020 were not associated with age-standardized cancer mortality rates. Although the US had the highest per capita spending on cancer care, after adjustment for smoking, the US cancer mortality rate was comparable with that of the median high-income country.

          Meaning

          Results of this cross-sectional study suggest that understanding how countries outside the US achieve lower cancer mortality rates with lower spending may prove useful to future researchers, clinicians, and policy makers seeking to best serve their populations.

          Abstract

          Importance

          Studies using data from before 2011 concluded that the cost of US cancer care is justified given improved outcomes compared with European countries. However, it is unclear whether contemporary US cancer care provides better value than that of other high-income countries.

          Objective

          To assess whether cancer mortality rates in 2020 were lower in countries with higher cancer-related spending, and to estimate across countries the incremental cost per averted cancer death.

          Design, Setting, and Participants

          Cross-sectional, national-level analysis of 22 high-income countries, assessing the association between cancer care expenditures and age-standardized population-level cancer mortality rates in 2020, with and without adjustment for smoking. In addition, US incremental costs per averted death compared with the other countries were calculated. This study was conducted from September 1, 2021, to March 31, 2022.

          Main Outcomes and Measures

          Age-standardized population-level cancer mortality rates.

          Results

          In this cross-sectional study of 22 countries, the median cancer mortality rate was 91.4 per 100 000 population (IQR, 84.2-101.6). The US cancer mortality rate was higher than that of 6 other countries (86.3 per 100 000). Median per capita spending in USD for cancer care was $296 (IQR, $222-$348), with the US spending more than any other country ($584). After adjusting for smoking, 9 countries had lower cancer care expenditures and lower mortality rates than the US. Of the remaining 12 countries, the US additionally spent more than $5 million per averted death relative to 4 countries, and between $1 and $5 million per averted death relative to 8 countries. Cancer care expenditures were not associated with cancer mortality rates, with or without adjustment for smoking (Pearson R = −0.05 [95% CI, −0.46 to 0.38]; P = .81; and R = −0.05 [95% CI, −0.46 to 0.38]; P = .82).

          Conclusions and Relevance

          In this cross-sectional study of national cancer care expenditures and cancer mortality rates across 22 countries, although the cancer mortality rate in the US was lower than the median, the US spent twice as much on cancer care as the median country. Findings of this study suggest that the US expenditure on cancer care may not be commensurate with improved cancer outcomes.

          Abstract

          This cross-sectional study assesses whether cancer mortality rates in 2020 were lower in countries with higher cancer-related spending and estimates across countries the incremental cost per averted cancer death.

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          Most cited references66

          • Record: found
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          • Article: not found

          Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

          This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.
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            Is Open Access

            Estimation of the Percentage of US Patients With Cancer Who Are Eligible for and Respond to Checkpoint Inhibitor Immunotherapy Drugs

            Key Points Question What is the estimated percentage of US patients with cancer who are eligible for and respond to checkpoint inhibitor drugs approved for oncology indications by the US Food and Drug Administration? Findings This cross-sectional study found that the estimated percentage of US patients with cancer who are eligible for checkpoint inhibitor drugs increased from 1.54% in 2011 to 43.63% in 2018. The percentage of patients estimated to respond to checkpoint inhibitor drugs was 0.14% in 2011 and increased to 12.46% in 2018. Meaning The estimated percentages of patients who are eligible for and who respond to checkpoint inhibitor drugs are higher than reported estimates for drugs approved for genome-driven oncology but remain modest.
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              • Record: found
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              Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States

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                Author and article information

                Journal
                JAMA Health Forum
                JAMA Health Forum
                JAMA Health Forum
                American Medical Association
                2689-0186
                27 May 2022
                May 2022
                27 May 2022
                : 3
                : 5
                : e221229
                Affiliations
                [1 ]MD-PhD Program, Yale School of Medicine, New Haven, Connecticut
                [2 ]Vassar College, Poughkeepsie, New York
                [3 ]Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
                [4 ]Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, Connecticut
                Author notes
                Article Information
                Accepted for Publication: April 6, 2022.
                Published: May 27, 2022. doi:10.1001/jamahealthforum.2022.1229
                Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Chow RD et al. JAMA Health Forum.
                Corresponding Author: Cary P. Gross, MD, Yale School of Medicine, PO Box 208056, 333 Cedar St, New Haven, CT 06520-8056 ( cary.gross@ 123456yale.edu ).
                Author Contributions: Drs Chow and Gross had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
                Concept and design: Chow, Gross.
                Acquisition, analysis, or interpretation of data: Chow, Bradley.
                Drafting of the manuscript: Chow.
                Critical revision of the manuscript for important intellectual content: All authors.
                Statistical analysis: Chow.
                Supervision: Gross.
                Conflict of Interest Disclosures: Dr Gross reported receiving grants from the National Comprehensive Cancer Network Foundation (funds provided by AstraZeneca), personal fees from Genentech Research (support for cancer equity research), and grants from Johnson & Johnson (support for developing new models of clinical trial data sharing) outside the submitted work. No other disclosures were reported.
                Additional Contributions: We thank Xiao Xu, PhD (Yale School of Medicine) for insightful suggestions on data visualization, which were provided without compensation.
                Article
                aoi220024
                10.1001/jamahealthforum.2022.1229
                9142870
                35977250
                bae3f042-71fa-44a1-98d4-e236ee6db3f9
                Copyright 2022 Chow RD et al. JAMA Health Forum.

                This is an open access article distributed under the terms of the CC-BY License.

                History
                : 16 February 2022
                : 6 April 2022
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