Cost effectiveness of cancer prevention interventions

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Written by Angelica Leon on Monday, July 18, 2016

Considerable evidence has shown that cancer prevention interventions have many direct benefits, such as reducing the incidence of disease and increasing the quality of life. However, there are also indirect economic benefits including increasing productivity and decreasing absenteeism rates at the worksite.

Throughout this blog series, we have discussed different interventions implemented in our home countries – Canada, Iran, Ireland, Mexico, and Pakistan – that aim to tackle the risk factors the World Health Organization (WHO) considers to be responsible for 30% of cancer occurrences worldwide: tobacco use, diet, and physical activity.

However, how can we determine whether these interventions are a good use of resources? There are many indicators used in health care to assess the value of a public health intervention, and one frequently-used metric is cost effectiveness. This indicator involves calculating a ratio that measures the balance between cost and health benefits that are not monetized (typically, lives saved). When the benefits are higher than the costs, the intervention is deemed cost effective.

For the purposes of this post, we have compared the direct cost of cancer to the cost of prevention. It is important to mention that indirect costs of cancer are a very important component of the overall cost of cancer. Because data about these costs are not available, the direct cost data we discuss below are underestimates of the true fiscal impact of cancer.

Note: It is also important to mention that during the research for this post, country-specific data were difficult to find, especially for Iran and Pakistan.

How much does cancer cost?

There are many factors involved in estimating the overall cost of cancer. There are direct costs associated with medical attention, such as hospitalization, medications, and physician visits. There are also indirect costs that are not associated with health care expenditures, such as loss of productivity, travel, and out of pocket expenses.

We have shown the direct cancer costs in three of our home countries in Table 1. Unfortunately, data was not available for Iran or Pakistan.

Table 1. Cancer expenditures

Country

Direct cancer cost as % of health care expenditure

Direct cancer cost per capita (USD)

Canada

6.7%

157

Iran

NA

NA

Ireland

6.6%

139.7

Mexico

NA

1,146

Pakistan

NA

NA

 

It is also important to mention that all of these countries have widely differing health care systems with varying levels of public sector funding, private insurance, and use of pharmaceuticals, which leads to differences in cancer-related expenditures.

How much does prevention cost?

As mentioned previously, the interventions we have discussed in this series of posts are based on changing individual behaviours, which are difficult to change. However, once a behaviour has been changed and maintained, the benefits can be seen in the long term.

Despite this, the WHO estimates in its Global Action Plan it will cost around 11 billion USD to implement interventions for prevention and control of non-communicable diseases targeting insufficient physical activity, tobacco use and obesity, among others. In contrast, the WHO estimates it will cost 7 trillion USD if no action is taken.

Let’s review the costs and benefits of each of the risk factor interventions we have reviewed in our blog series:

Tobacco use

Tobacco is responsible for 90% of lung cancer cases, and it has shown to be linked to many other cancer types as well. In 2005, as a response to the burden of tobacco use, Canada, Iran, Ireland, Mexico, and Pakistan signed the WHO Framework Convention on Tobacco Control. This framework establishes international measures for tobacco control, including specifications on packaging and marketing restrictions, taxation on tobacco products, and laws restricting smoking in public places.

According to the WHO Report on the Global Tobacco Epidemic, government expenditures on smoking prevention vary greatly among these five countries, and so do the estimated expenditures on smoking-related health costs.

Table 2. Smoking prevention interventions budget and costs

Country

Smoking prevention budget

(million USD)

Smoking-related health care cost

(billion USD)

Canada

33.57

0.7

Iran

1.50

8.57

Ireland

1.82

0.52

Mexico

0.01

4.13

Pakistan

0.03

1.3 - 1.85*

*Estimated using Bangladesh experience

 

Table 2 shows that Canada and Ireland have the lowest health care expenditures related to smoking and the highest budget for smoking cessation programs. It is important to mention that the high-income countries and low-middle income countries are in very different stages of implementing tobacco control policies. Whereas high-income countries are now seeing the effects of the interventions as a reduction on incident cases, low-income countries are still implementing the interventions and the effects are yet to be determined.

Overweight and obesity

The prevalence of obesity has increased rapidly worldwide, and obesity has been linked to several types of cancer. There are many factors contributing to the increase in body weight, including those discussed in our blog series: nutrition and physical activity.

In terms of nutrition, the most important interventions we discussed were laws on food labeling and marketing restrictions for children, as well as special programs for children and adolescents. For physical activity, we discussed active commuting programs and media campaigns to promote physical activity.

Government reports and research show that Canada and Mexico have the highest budget to tackle overweight and obesity as well as the higher health related costs:

Table 3. Overweight and obesity budget and costs

Country

Obesity prevention budget

(million USD)

Obesity-related health care cost

(billion USD)

Canada

158

5.61

Iran

NA

0.59

Ireland

14.56 (1, 2)

1.86

Mexico

192

2.31

Pakistan

NA

NA

 

According to an OECD report, implementing an obesity prevention intervention can prevent approximately 25,000 deaths from chronic disease in Canada and approximately 47,000 in Mexico.

What can be done?

Since cost effectiveness does not include non-health related benefits, such as return on investment (ROI), opinions and evidence are divided about the cost-effectiveness of prevention programs. Some studies support the assertion that prevention is a cost-effective strategy. However, other studies suggest that prevention only adds to health care costs in the long term, due to increase in longevity and lifetime demand on health care services.

However, let’s not forget that the benefits of prevention go beyond people not getting sick. Prevention interventions can increase quality of life, save lives, tackle health inequalities, and increase the number of productive years. Moreover, prevention also presents a less expensive way to improve health when compared to most treatments.

The single best answer to the fight against cancer is to invest in prevention strategies. The challenge is how we are to allocate resources to get the most benefit on every dollar spent, which requires having a comprehensive plan that includes primary prevention as an important component of  reducing the incidence of cancer. There is also a great opportunity in low-middle income countries to provide evidence and data that would help decision-makers make informed decisions on prevention.

Read other posts in the series >

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