Journal
LANCET ONCOLOGY
Volume 12, Issue 10, Pages 933-980Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/S1470-2045(11)70141-3
Keywords
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Categories
Funding
- Pfizer
- Novartis
- Celgene
- Amgen
- Sandoz
- Helsinn
- Johnson Johnson
- Roche
- Merck
- Pierre Fabre
- Hospira
- Aveo Pharmaceuticals
- Bayer
- Genentech
- Heathwell Foundation
- MerckSerono
- Sanofi
- AstraZeneca
- Genomic Health
- Saladax
- Sanofi-Aventis
- Veridex
- Actelion Pharmaceuticals
- Allergan
- Alnylam Pharmaceuticals
- Amylin Pharmaceuticals
- Astellas Pharma
- Bristol-Myers Squibb
- Inspire Pharmaceuticals
- Kureha Corporation
- Medtronic
- Merck Co
- Nabi Biopharmaceuticals
- NovaCardia
- OSI Eyetech
- Sanofi-Aventis US
- Scios
- Tengion
- Theravance
- Thomson Healthcare
- Vertex Pharmaceuticals
- Advanced Health Media
- Certified Medical Representatives Institute
- Commonwealth Fund
- EnablEd
- Forest Laboratories
- GlaxoSmithKline
- LifeMasters Supported SelfCare
- McKinsey Company
- Medical Decisions Network Medtronic
- National Pharmaceutical Council
- Novo Nordisk
- Orexigen Therapeutics
- Quintiles Transnational Corp
- Social and Scientific Systems
- Wallen and Associates
- WebMD
- NICE
- Department of Health
- Alliance Boots
- Pharmaceutical Research and Manufacturers of America
- Conquer Cancer Foundation
- Greenwall Foundation for Bioethics
- Chair's Fund
- UCLA Department of Radiation Oncology
- Herculesstichting and Fonds Wetenschappelijk Onderzoek-Vlaanderen
- UK Department of Health NIHR Biomedical Research Centre
- Department of Health via the National Institute for Health Research (NIHR) Comprehensive Biomedical Research Centre
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The burden of cancer is growing, and the disease is becoming a major economic expenditure for all developed countries. In 2008, the worldwide cost of cancer due to premature death and disability (not including direct medical costs) was estimated to be US$895 billion. This is not simply due to an increase in absolute numbers, but also the rate of increase of expenditure on cancer. What are the drivers and solutions to the so-called cancer-cost curve in developed countries? How are we going to afford to deliver high quality and equitable care? Here, expert opinion from health-care professionals, policy makers, and cancer survivors has been gathered to address the barriers and solutions to delivering affordable cancer care. Although many of the drivers and themes are specific to a particular field-eg, the huge development costs for cancer medicines-there is strong concordance running through each contribution. Several drivers of cost, such as over-use, rapid expansion, and shortening life cycles of cancer technologies (such as medicines and imaging modalities), and the lack of suitable clinical research and integrated health economic studies, have converged with more defensive medical practice, a less informed regulatory system, a lack of evidence-based sociopolitical debate, and a declining degree of fairness for all patients with cancer. Urgent solutions range from re-engineering of the macroeconomic basis of cancer costs (eg, value-based approaches to bend the cost curve and allow cost-saving technologies), greater education of policy makers, and an informed and transparent regulatory system. A radical shift in cancer policy is also required. Political toleration of unfairness in access to affordable cancer treatment is unacceptable. The cancer profession and industry should take responsibility and not accept a substandard evidence base and an ethos of very small benefit at whatever cost; rather, we need delivery of fair prices and real value from new technologies.
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