Abstract
BackgroundCancer outcomes vary widely among different countries. However, comparisons of cost-effectiveness and cost-efficiency of different systems are complex because the incidences of different cancers vary across countries and their chances of cure also differ substantially. We aim to propose a new standardized method for global comparison and to explore its relationship with economic indicators.MethodsCancer statistics from all 184 countries and 27 cancers listed in GLOBOCAN 2012 were analyzed. The complement of age-standardized mortality/incidence ratio [1 – (ASM/ASI)] was taken as the proxy relative survival (RS). Accounting for various country-specific cancer patterns, the cancer site-standardized proxy RS (proxy SS-RS) of individual countries were calculated by weighting the proportion of specific cancer sites as compared with the global pattern of incidence. Economic indicators of different countries listed by the World Bank were correlated with corresponding proxy SS-RS.ResultsSubstantial variation in site-specific survival and new case distribution supported the use of proxy SS-RS, which ranged from 0.124 to 0.622 (median 0.359). The median total health expenditure per capita (HEpc) increased from US$44 for countries with proxy SS-RS < 0.25, to US$4643 for countries with proxy SS-RS ≥0.55. Results from logarithmic regression model showed exponential increase in total HEpc for better outcome. The expenditure varied widely among different strata, with the widest difference observed among countries with SS-RS ≥0.55 (total HEpc US$1412–$9361).ConclusionsSimilar to age-standardization, cancer site-standardization adjusted for variation in pattern of cancer incidence provides the best available and feasible strategies for comparing cancer survivals across countries globally. Furthermore, cancer outcome correlated significantly with economic indicators and the amount of HEpc escalated exponentially. Our findings call for more in-depth studies applying cancer-site standardization to provide essential data for sharing of experience and urgent actions by policy makers to develop comprehensive and financially sustainable cancer plan for greater equity.
Highlights
Cancer outcomes vary widely among different countries
One acceptable surrogate for relative survival (RS) is to use the complement of the ratio of age-standardized mortality/incidence rate [1 – (ASM/age-standardized rates of incidence (ASI))] and this is supported by the study by Vostakolaei et al on 32 cancer sites in seven Western countries [4]
Sources of data The cancer outcome data were based on the GLOBOCAN 2012 [1]: age-standardized rates of incidence (ASI) and mortality (ASM) from all 184 countries/regions were retrieved
Summary
Cancer outcomes vary widely among different countries. Cancer outcomes vary widely among different countries due to multiple factors including variation in pattern of cancers, national cancer screening policy, presenting stage, access to good quality treatment (e.g., radiotherapy and systemic therapy), and cultural barriers. Assessment of outcomes data is fundamental for gauging the results achieved by individual country and goal-setting the target achievable with contemporary provision. This is not straightforward because many cancer registries, especially those in less developed regions, do not have prospectively collected individual patient record for calculation of relative survival (RS) [1]. One acceptable surrogate for RS is to use the complement of the ratio of age-standardized mortality/incidence rate [1 – (ASM/ASI)] and this is supported by the study by Vostakolaei et al on 32 cancer sites in seven Western countries [4]
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