Abstract
Health care expenses in the United States are increasing inexorably. At the current rate of growth, it is anticipated that 20% of the gross national product will consist of health-related expenditures within the next decade. Cancer is the second leading cause of death in the United States, and it is increasing in prevalence because of the aging of the population and the limited number of successful prevention strategies. As the biological characteristics of cancer come into sharper focus, targeted therapies are being developed that offer the promise of increased clinical benefit with fewer toxicities than are associated with conventional treatment. Although spectacular successes are infrequent with this approach, to date, the majority of targeted therapies are modestly effective at best, and extremely costly. This observation suggests that a broadly acceptable definition of value in a cancer therapeutic agent is not at hand, but is sorely needed from the vantage points of the patient and society. A corollary issue of enormous import is how to equitably distribute the health care dollar in the service of achieving the greatest good for the greatest number. Although cancer is responsible for only 5% of the health care budget, its cost is increasing and it can be viewed as paradigmatic when contemplating the problem of equity in health care. Here, a number of concepts are discussed that focus on this goal and its implications for the cancer patient and society at large.
Highlights
Health care expenses in the United States are increasing inexorably
Health care costs in the United States are increasing at a rate that exceeds overall economic growth
It is estimated that 20% of the gross national product will be allocated to health care in 2020
Summary
The burden on society The absolute number of dollars spent on cancer care during the periods between 1987 and 2001 to 2005 doubled, increasing from $24 billion to $48.1 billion per year. Despite the fact that the two systems are entirely different, the basis for the difference almost certainly relates to the fact that NICE concluded that a number of these agents did not bring sufficient value to the patient to justify their use when compared with the importance of the programs and/or practices that would have to be dropped The latter decision is often arrived at by a straightforward calculation that determines the incremental cost-effectiveness ratio (ICER). The large number of uninsured, and the underinsured (those whose insurance contains various limits that result in it not covering the costs of a serious illness), are extremely vulnerable to the costs of contemporary cancer treatment This conundrum is leading many patients to forgo or diminish the use of these therapies at significant danger to their lives and well-being [16, 17]. As it has been discussed above, is only one of the two broad goals or standards for health care resource allocation; the other is equity across the population served by the health care system
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