Evaluation of the Global Pattern of Cancer Survival and the Correlation With Healthcare Expenditures

Abstract

Background: Cancer is a global health burden; the outcome varies widely across all countries. Sharing of experience in setting health policy (including health expenditure) is important. However, there is yet no comprehensive comparison of cancer outcome across all countries. Furthermore, comparison of cost-effectiveness of different systems is especially complex because the incidence of different cancers varies across countries, and their chances of curability differ substantially. Aim: We aims to provide the comparisons using available data and to stimulate global attention to the association of economic parameters with different outcomes. Methods: Cancer statistics from all 184 countries and 27 major cancers listed in GLOBOCAN 2012 were analyzed. The overall outcome of cancer patients was estimated by taking the complement of age-standardized mortality/incidence ratio [1 − (ASM/ASI)] as the proxy relative survival (RS). Taking into account the variation of country-specific cancer pattern, the proxy cancer site-standardized RS (SS-RS) of individual countries were calculated by weighting the proportion of specific cancer sites as compared with the global pattern of incidence. The overall economic parameters of different countries listed by the World Bank were correlated with the corresponding proxy SS-RS. Results: The unadjusted proxy RS among the 184 countries ranged from 0.111 to 0.702 (median = 0.386), the corresponding proxy SS-RS ranged from 0.124 to 0.622 (median = 0.359). The median total health expenditure per capita (HE) increased from US$37 for countries with proxy SS-RS < 0.2, to $4255 for countries with proxy SS-RS ≥ 0.5. Results from logarithmic regression model showed exponential increase in total HE for better outcome. The expenditure varied widely among different strata, but the widest difference was observed among countries with SS-RS ≥ 0.5 (with total HE ranging from US$962 to $9361). Conclusion: Similar to age-standardization, estimation of outcome with adjustment for variation in pattern of cancer incidence is suggested for comparison among different countries, especially for studies related to assessment of health systems. Cancer outcome correlated significantly with economic parameters; the amount of HE escalated exponentially and varied widely among countries with high SS-RS ≥ 0.5. Sharing of experience among different countries will be valuable for developing the most cost-effective health system.© 2018 by American Society of Clinical Oncology