Is it worth it?

The United States consistently spends more than other nations on health care and is rewarded by the World Health Organization as having the #37 health care system. But is the money spent worth it? In the case of cancer care, the answer is yes.

It’s nice to finally be on the winning team of international health statistics. That is, it feels great to have someone actually touting how the United States does a good job by pouring lots of money into its healthcare system.  Let’s just bask in the glory for a second.

Normally the United States is looked upon as an example of ‘what not to do’ in global health circles. The World Health Organization consistently reports that the U.S. runs in the middle of the pack of ranked United Nations states in terms of infant mortality, life expectancy, and other important markers of health.  What’s more, the U.S. spends much more per capita on health care than all other countries that have better health statistics per WHO metrics.

That is why it is pleasantly surprising that a recent study shows that while the United States spends more than Europe (as represented by ten European countries) on cancer care, the U.S. is rewarded with better clinical outcomes for those cancer patients.

Specifically, by reviewing large patient databases from the United States and ten European countries, researchers were able to show that patients with cancer in the U.S.  have a longer survival time after diagnosis and show a decrease in overall cancer-specific mortality throughout the years studied (1983-1999).  On average, people with cancer in the U.S. survive 1-2 years longer after their cancer diagnosis than their counterparts in Europe.

For patients diagnosed with cancer from 1983-99, the survival after time of diagnosis increased at a greater rate from year to year in the United States as compared to the European cohort. This represents real survival gains over time.  With the value of a life-year set at $150,000, the U.S. – on average – experienced a net value survival gain of $61,000 more than Europe per cancer patient.  Meanwhile in this same 17 year period, U.S. spending on cancer care increased from $47,000 per patient to $70,000 per patient, a 49 percent increase.  In Europe, spending on cancer care only increased 16 percent, from $38,000 per case to $44,000.

Cancer mortality rates fell faster in the United States than in Europe over the same time period, suggesting that survival gains were not due to earlier diagnosis but to more effective treatment in the setting of higher expenditures on cancer care.

Commentary

Wow, that was nice to talk about!  But running the risk of coming down off of our pro-USA kick, let’s take a step back.

This same study also makes it apparent that despite its lower cancer mortality rate, the United States has a higher incidence of cancer than the compared European countries.  Although this study suggests that current cancer care in the U.S is quite effective and therefore increased spending on cancer care does save more lives, a serious question remains. How many more lives could be saved with that same amount of money if put toward cancer prevention rather than cancer treatment?

How many people with cancer would trade that one year of extended survival after their cancer diagnosis to prevent many other people from having cancer in the first place?

As is displayed through the World Health Organization’s indicators of health, the United States may do extraordinary things with its advanced tertiary and quaternary health care system. However, the lack of focus on the primary health care system inhibit our national potential to improve health outcomes across the board.

Philipson, T., et al. “An analysis of whether higher health care spending in the United States versus europe is ‘worth it’ in the case of cancer.” Health Affairs. 2012 Apr; 31 (4): 667-75.

by

Lisa Maurer, MD