Department of Medical Oncology, Salpetriere Hospital, Paris, France. dk@cancer med.fr
Cancer. 2012 May 1;118(9):2367-71. doi: 10.1002/cncr.26496. Epub 2011 Sep 14.
The costs of cancer care are rising, and spending on expensive innovative anticancer agents is likely to come under scrutiny as health care payers are confronted by the challenge of resource limits in the face of infinite demand. Indirect costs account for the major part of total attributable costs of cancer and are dominated by the cost of mortality in individuals of working age (who therefore do not contribute to economic productivity). Although cancer is a leading cause of morbidity and premature mortality, in 2007, it was estimated that cancer accounted for only around 6% of the total health care costs in Europe. It is estimated that cancer drug costs constitute around 12% of total direct cancer costs and 5% of the costs of all drugs. Countries vary in their uptake of novel anticancer agents. However, even in France--a leading nation for the use of these agents--the costs of innovative anticancer drugs accounted for <0.6% of total health care expenditure in 2006. Population-level data suggest that novel therapies have contributed (together with advances in screening and other aspects of care) to improvements in survival from cancer. If this is the case, then the potential reduction in the associated indirect costs could exceed the direct costs associated with the uptake of innovative drug therapies. Further research is required to establish the costs and benefits of novel agents in routine practice.
癌症治疗的成本不断上升，随着医疗保健支付者面临资源有限与无限需求的挑战，昂贵的创新抗癌药物的支出可能会受到审查。间接成本占癌症总可归因成本的主要部分，主要由工作年龄个体的死亡率成本（因此他们不会对经济生产力做出贡献）决定。尽管癌症是发病率和过早死亡的主要原因，但据估计，2007 年，癌症仅占欧洲总医疗保健费用的 6%左右。据估计，癌症药物成本约占直接癌症总成本的 12%和所有药物成本的 5%。各国对新型抗癌药物的采用情况存在差异。然而，即使在法国——这些药物使用的领先国家——2006 年创新抗癌药物的成本也仅占总医疗保健支出的<0.6%。人群水平的数据表明，新型疗法（连同筛查和护理的其他方面的进步）有助于提高癌症的生存率。如果情况确实如此，那么与采用创新药物治疗相关的间接成本的潜在减少可能会超过直接成本。需要进一步研究以确定常规实践中新型药物的成本和效益。
