Economic factors in cancer palliation—methodologic considerations

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The role of economic factors in the care of cancer patients has been receiving increasing attention in recent years (l-3) as it has become increasingly apparent in most health care systems that health care resources are not unlimited. There is greater demand for health care personnel, time, facilities, equipment and money than there is supply. Because of this imbalance decisions must be made regarding allocation of available resources and it is important that health care professionals understand how economic factors are evaluated, the role they play in health care decision making and the limitations of their contributions to the health care decisionmaking process. Decisions about resource allocation may either be made explicitly, after consideration of all relevant factors, including cost, or they may be made on an ad hoc basis. When the latter approach is taken, those most able to pay are more likely to receive care in user-pay systems whereas a first-come, first-served approach is likely to be taken in publically funded systems. In either situation, scarce health care resources will probably be allocated to marginally useful procedures for some patients at the same time that highly effective (and affordable) treatment is denied to others, It is only when resource allocation decisions are made explicitly, and economic factors considered directly, that the most equitable distribution of resources possible can be achieved. Even when there is agreement that economic factors should be incorporated into health care decisions, these factors should never be taken in isolation. Other factors that should be considered include treatment efficacy/effectiveness, treatment toxicity and effect on quality of life, availability of resources for treatment administration, acceptability of treatment (and non-treatment) to patients, health care professionals and society, societal and political preferences (e.g. that children should receive more than their ‘share’ of health care resources) and individual physician and patient preferences (4). The latter are most relevant when treatment decisions are being made for individual patients and they may lead to conflicfs between clinicians and policy makers. Health care professionals are often uncomfortable when asked to examine the