MD-PhD Program, Yale School of Medicine, New Haven, Connecticut.
Vassar College, Poughkeepsie, New York.
JAMA Health Forum. 2022 May 27;3(5):e221229. doi: 10.1001/jamahealthforum.2022.1229. eCollection 2022 May.
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.
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.
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.
Age-standardized population-level cancer mortality rates.
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 = -0.05 [95% CI, -0.46 to 0.38]; = .81; and = -0.05 [95% CI, -0.46 to 0.38]; = .82).
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.
使用 2011 年之前数据的研究得出结论，与欧洲国家相比，美国癌症护理的改善结果证明了其成本是合理的。然而，目前尚不清楚当代美国癌症护理是否比其他高收入国家提供更好的价值。
评估在癌症相关支出较高的国家，2020 年癌症死亡率是否较低，并估算每个国家避免癌症死亡的增量成本。
设计、设置和参与者：这是一项在 22 个高收入国家进行的横断面、国家级分析，评估了 2020 年癌症护理支出与年龄标准化人群癌症死亡率之间的关联，同时考虑了和未考虑吸烟因素的调整。此外，还计算了与其他国家相比，美国每避免一例死亡的增量成本。本研究于 2021 年 9 月 1 日至 2022 年 3 月 31 日进行。
年龄标准化人群癌症死亡率。
在这项对 22 个国家的横断面研究中，中位癌症死亡率为每 10 万人 91.4 例（IQR，84.2-101.6）。美国的癌症死亡率高于其他 6 个国家（每 10 万人 86.3 例）。癌症护理的人均支出以美元计为 296 美元（IQR，222-348），美国的支出超过任何其他国家（584 美元）。在调整吸烟因素后，有 9 个国家的癌症护理支出和死亡率低于美国。在其余 12 个国家中，美国每避免一例死亡还额外花费了 500 多万美元，比 4 个国家多，比 8 个国家多花费了 100 万至 500 万美元。癌症护理支出与癌症死亡率无关，无论是否调整吸烟因素（Pearson = -0.05 [95% CI，-0.46 至 0.38]； = .81；和 = -0.05 [95% CI，-0.46 至 0.38]； = .82）。
在这项对 22 个国家的国家癌症护理支出和癌症死亡率的横断面研究中，尽管美国的癌症死亡率低于中位数，但美国在癌症护理上的支出是中位数国家的两倍。本研究的结果表明，美国在癌症护理上的支出可能与改善的癌症结果不相符。
