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Cancers and tumours cost every country a lot of money. In Scotland the total amount spent on cancer services (excluding cancer screening programmes) was about £475 million in 2007. This was not only written by three experts in healthcare improvement and economics, it was also published by the Scottish Government, therefor it is a very reliable source. In the U. S. , however, it is estimated that cancer care expenditures will be as much as 157 billion dollars. Clearly, there is great variation between the cancer expenditures of different countries globally, even when those countries have approximately the same level of national income. This source was published by The Lancet Oncology, a medical journal that had the second highest impact factor (79. 258) in 2017. The authors are all experts in this field, and work at the Health Economics Research Centre, and King’s Health Partners Cancer Centre and Institute for Cancer Policy. Thus, this source is extremely trustworthy. However, that same issue of The Lancet Oncology features an article that explains how an inconsistent quality of data makes it difficult to compare different countries accurately on their comparative expenditure and effectiveness on health care. Several EU countries that are spending less money annually on cancer care, are actually achieving superior outcomes. This is because they consider better long-term practices and are thus more cost effective. All these authors are again experts in oncology.
So what are cost effective cancer treatments? Radiotherapy, which is of great importance in over half of all newly diagnosed cancers, is financially a better choice than surgery and chemotherapy. The source I used about the amount of radiotherapy is over 10 years old. Nevertheless, nowadays radiotherapy is still a crucial component in the majority of cancer treatments. However, as mentioned before, countries differ greatly in their investments in cancer care, not only in the amount of money invested, but also the way it is invested. Although EU countries have different policies concerning investments, since 2006 there has been a collaboration between all EU countries except Slovakia and Bulgaria. This collaboration is called the European Network for Health Technology Assessment, or EUnetHTA, and values universality, access to good quality care, equity and solidarity. Their focus is not limited to cancer care, but it makes research more available and can thus be of great help in making cancer care in more countries better and more cost effective.
Canada approaches healthcare with similar principles, namely “Access must be based on medical need and not the ability to pay. ” Because care has to be accessible to everyone, whatever their income may be, it is very important to Canada that their treatment is cost effective. This is noticeable in their multiple programs that track progress against cancer, such as the Cancer Quality Council of Ontario (CQSO). The CQSO is one of Canada’s first Health Councils, and releases the Cancer System Quality Index (CSQI) annually. In the CSQI cancer care is monitored using seven categories: safety; effectiveness; accessibility; responsiveness (patient-centered); equitability; integration; and efficiency. So, for Canada, cost-effectiveness is in one of the highest categories of evaluating the clinical value of cancer care, but it’s not the be-all and end-all. Whereas Canada has organisations such as the previously discussed CQCO, the US has the United States Food and Drug Administration (US FDA or FDA). The FDA is able to grant approval of a drug. Before they can do this, the drug company must send their tests to the Center for Drug Evaluation and Research (CDER), proving the safety and effectiveness of the drug. If the CDER approves, then the FDA can too. Interestingly the US FDA does not exclude therapies similar to already approved therapies, meaning lots of money can get invested in drugs and therapy that could be considered superfluous. Furthermore, the FDA is not involved in costs, nor does it consider them. Money is therefore neither a factor in the approval of a drug nor in the distribution of it.
Research actually suggests that not only are therapies expensive, they might deliver the benefits everyone hopes for. Fojo and Grady are both experts in medical oncology, and are affiliated with the Center for Cancer Research, National Cancer Institute (TF), and Department of Bioethics, The Clinical Center (CG), and National Institutes of Health. Furthermore their article is published in the JNCI, that had a high impact factor of 14. 069 that year. This source is therefore very reliable. Stewart, Whitney, and Kurzrok are all from The University of Texas M. D. Anderson Cancer Center and Baylor College of Medicine, which has ranked among the nation’s top two cancer hospitals in U. S. News & World Report’s “America’s Best Hospitals” survey. This source is therefore reliable as well.
Thus, contrary to the EU and Canada, the US puts less emphasis on the cost effectiveness of drugs and therapies. However, this does not necessarily result in better drugs.
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