The results, published in The Lancet Oncology, reveal substantial disparities between different countries in the EU in spending on health care and drugs for cancer, with Luxembourg and Germany spending the most on health care for cancer per person, and Bulgaria spending the least. Overall, expenditure on drugs for cancer accounted for around a quarter of the total cost (€14 billion). Spending on cancer medications as a percentage of health care costs was lowest in Lithuania, and highest in Cyprus.
A team of researchers from the Health Economics Research Centre, at the Nuffield Department of Population Health, University of Oxford, UK, and from King's College London, Institute of Cancer Policy and KHP Cancer Centre UK, collated data obtained from international health organisations (WHO and EUROSTAT), as well as national ministries of health and statistical institutes to estimate the total cost of cancer across the EU in 2009, the most recent year for which comprehensive data were available.
The overall calculation included the cost of health care for cancer (including the cost of drugs), the cost of productivity losses (due to premature death, and people being unable to work due to illness), and the cost of informal care from friends and relatives, estimating the overall cost in 2009 to be €126 billion.
Around two fifths (€51 billion) of this cost was incurred by health care systems, with the rest incurred by patients' families, friends, and society overall. Friends and relatives of people with cancer were estimated to have provided 3 billion hours of unpaid care overall, valued at €23.2 billion. Lost productivity – due to premature deaths and illness from cancer – was estimated to have cost €52 billion.
The researchers also examined the different contribution of the four cancers which in the EU contribute to around half of all new cancer diagnoses and deaths – breast cancer, colorectal cancer, lung cancer, and prostate cancer. They found that lung cancer had the highest overall cost, at €18.8 billion (just over a tenth of the total), and was also responsible for the biggest loss of productivity. Health care costs were highest for breast cancer (€6.7 billion, 13% of total cancer-related health care costs), largely due to a high rates of spending on drugs for this illness.
What is more, the researchers point out that these estimates are conservative, as some categories of health care costs, such as screening programmes, were not included due to the inability to obtain these data for all countries under study.
According to Dr Ramon Luengo-Fernandez, University of Oxford, UK, "This is the first ever comprehensive EU-wide study which allows us to not only estimate the total cost of cancer in the EU, but also to make meaningful comparisons between countries. We hope that these results will allow policymakers to better allocate research funds, and to deliver cancer services in a way that provides good value for money."*
Previously, the same researchers used the same methods to estimate the economic burden due to cardiovascular disease, allowing these estimates to be compared to the new figures for cancer. While the overall economic burden due to cardiovascular disease in the EU is higher than that for cancer (€195 billion vs €126 billion), the cost of productivity losses due to premature death was nearly twice as high for cancer as that for cardiovascular disease (€43 billion vs €27 billion), reflecting the higher number of cancer-related deaths in people of working age.
Professor Richard Sullivan, King's College London, said: "It is vital that decision-makers across Europe use this information to identify and prioritise key areas. More effective targeting of investment may prevent health care systems from reaching breaking point – a real danger given the increasing burden of cancer – and in some countries better allocation of funding could even improve survival rates."*
Writing in a linked Comment, Professor Gary Lyman of Duke University School of Medicine, Durham, USA states that, "Implementation of high-quality cancer care is difficult without a thorough understanding of the total burden of disease and the resources needed to provide appropriate care…This is a comprehensive and detailed assessment of cancer costs in the EU from a societal perspective, modelled on similar previous work assessing the economic burden of cardiovascular disease and dementia in the EU."
NOTES TO EDITORS:
* Quotes direct from authors and cannot be found in text of Article
Journal
The Lancet Oncology