In a recent Health Affairs paper, we documented that the United States has a significant survival advantage over much of Europe when it comes to cancer: 1.8 years for those diagnosed during our study window. Furthermore, we showed over a 17-year period that this gap had widened, not narrowed, and that this widening was more valuable than traditional health valuation approaches suggest. As a result, we argued that the additional spending in the United States was ‘worth it.’
These results have generated a lot of controversy, and even some criticism. We understand the controversy given the impression that U.S. health care spending is too high. However, we find the criticism both irrelevant and misguided, both qualitatively and quantitatively.
More on cancer care in the United States and Europe at the Health Affairs blog.
Perhaps Americans are just a hardier people.
I wonder how Japan’s survival rates compare.
Lots of variables to be considered, but interesting.
I guess I still have a problem with them saying “cancer care” when it is really only prostate and breast cancer where there are substantial differences in mortality/survival (if I recall correctly). Why would higher spending only be helpful for those cancers but not any others?
And I don’t really see a persuasive explanation for the disparities that couldn’t be explained by the US’s higher frequency of screening for these diseases, and resultant overdiagnosis (lowering mortality rates by increasing the discovery of harmless cancers). This is a separate issue from lead-time bias, which they do address (not persuasively, in my opinion, though maybe I didn’t totally understand where the QALY explanation came in).
They pretty much are just citing themselves or another pharma-funded study when they dismiss lead-time bias as a confounder, so the potential for conflict of interest is difficult to overlook. It’s pretty clear to me why pharmaceutical companies would fund a study that shows that more health care spending is beneficial, and while I am not questioning the authors’ integrity, I think their claims are worthy of higher scrutiny.