Abstract
The premature cancer mortality rate has been declining in Switzerland, but there has been considerable variation in the rate of decline across cancer sites (e.g., breast or digestive organs). I analyze the effect that pharmaceutical innovation had on premature cancer mortality in Switzerland during the period 1995-2012 by investigating whether the cancer sites that experienced more pharmaceutical innovation had larger declines in premature mortality, controlling for the number of people diagnosed and mean age at diagnosis. Premature cancer mortality before ages 75 and 65 is significantly inversely related to the cumulative number of drugs registered 5, 10, and 15 years earlier. The number of drugs registered during 1980-1997 explains 63% of the variation across cancer sites in the 1995-2012 log change in the premature (before age 75) mortality rate. Controlling for the cumulative number of drugs, the cumulative number of chemical subgroups does not have a statistically significant effect on premature mortality. This suggests that drugs (chemical substances) within the same class (chemical subgroup) are not "therapeutically equivalent". Over 17,000 life-years before age 75 were gained in 2012 due to drugs registered during 1990-2007. The number of life-years before age 75 gained in 2012 from drugs registered during two earlier periods (1985-2002 and 1980-1997) were more than twice as great. Since mean utilization of new drugs is much lower than mean utilization of older drugs, more recent drug registrations may have a smaller effect on premature mortality than earlier drug registrations even if the average quality of newer drugs is higher. Estimates of the cost per life-year gained before ages 75 and 65 in 2012 from drugs registered during 1990-2007 are $21,228 and $28,673, respectively. These figures are below even the lowest estimates from the value-of-life literature of the value of a quality-adjusted life-year. The estimates indicate that the cost per life-year before age 75 gained from drugs registered during earlier periods (1985-2002 and 1980-1997) were considerably lower: $5299 and $3218, respectively. The largest reductions in premature mortality occur at least a decade after drugs are registered, when their utilization increases significantly. This suggests that if Switzerland is to obtain substantial additional reductions in premature cancer mortality in the future (a decade or more from now) at a modest cost, pharmaceutical innovation (registration of new drugs) is needed today.
Highlights
Previous authors have argued that ‘‘reducing premature mortality is a crucial public health objective’’ [16]
A widely used measure of premature mortality is years of potential life lost (YPLL) before a given age, i.e., the number of years not lived by an individual who died before that age [1]
Lichtenberg [10] found that estimates of the effect of pharmaceutical innovation on US cancer mortality rates were insensitive to the inclusion or exclusion of measures of non-pharmaceutical medical innovation
Summary
Previous authors have argued that ‘‘reducing premature mortality is a crucial public health objective’’ [16]. During the period 1995–2012, premature (before age 75) mortality from cancer of lymphoid, hematopoietic, and related tissue declined 31 %, and from breast cancer declined 38 %, but premature mortality from lip, oral cavity, and pharynx cancer increased 14 %, and from cancer of endocrine glands and related structures increased 19 %. This variation in the rate of decline of premature mortality cannot be explained by variation in the rate of decline of incidence.
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