Delivering affordable cancer care in high-income countries

被引：507

作者：

Sullivan, Richard ^{[1
]}

Peppercorn, Jeffrey ^{[2
]}

Sikora, Karol ^{[3
]}

Zalcberg, John ^{[4
]}

Meropol, Neal J. ^{[5
]}

Amir, Eitan ^{[6
,7
]}

Khayat, David ^{[8
]}

Boyle, Peter ^{[9
]}

Autier, Philippe ^{[9
]}

Tannock, Ian F. ^{[6
,7
]}

Fojo, Tito ^{[10
]}

Siderov, Jim ^{[11
]}

Williamson, Steve

Camporesi, Silvia ^{[12
]}

McVie, J. Gordon ^{[13
]}

Purushotham, Arnie D. ^{[14
]}

Naredi, Peter ^{[15
]}

Eggermont, Alexander ^{[16
]}

Brennan, Murray F. ^{[17
]}

Steinberg, Michael L. ^{[18
]}

De Ridder, Mark ^{[19
]}

McCloskey, Susan A. ^{[18
]}

Verellen, Dirk ^{[19
]}

Roberts, Terence ^{[18
]}

Storme, Guy ^{[19
]}

Hicks, Rodney J. ^{[20
]}

Ell, Peter J. ^{[21
]}

Hirsch, Bradford R. ^{[22
,23
]}

Carbone, David P. ^{[24
]}

Schulman, Kevin A. ^{[22
,23
]}

Catchpole, Paul ^{[25
]}

Taylor, David ^{[26
]}

Geissler, Jan ^{[27
]}

Brinker, Nancy G. ^{[28
]}

Meltzer, David ^{[29
,30
]}

Kerr, David ^{[31
]}

Aapro, Matti ^{[32
]}

机构：

[1] Kings Coll London, Kings Hlth Partners Integrated Canc Ctr, London SE1 9RT, England

[2] Duke Univ, Med Ctr, Duke Canc Inst, Durham, NC USA

[3] CancerPartnersUK, London, England

[4] Univ Melbourne, Peter MacCallum Canc Ctr, Melbourne, Vic, Australia

[5] Case Western Reserve Univ, Univ Hosp Seidman Canc Ctr, Case Comprehens Canc Ctr, Cleveland, OH 44106 USA

[6] Princess Margaret Hosp, Div Med Oncol & Hematol, Toronto, ON M4X 1K9, Canada

[7] Univ Toronto, Toronto, ON, Canada

[8] Hop La Pitie Salpetriere, Paris, France

[9] Int Prevent Res Inst, Lyon, France

[10] NCI, Med Oncol Branch, Ctr Canc Res, Bethesda, MD 20892 USA

[11] Austin Hlth, Canc Serv, Heidelberg, Vic, Australia

[12] Kings Coll London, Ctr Humanities & Hlth, London WC2R 2LS, England

[13] European Inst Oncol, Milan, Italy

[14] Kings Hlth Partners Integrated Canc Ctr, London, England

[15] Umea Univ, Dept Surg, Umea, Sweden

[16] Inst Gustave Roussy, Paris, France

[17] Mem Sloan Kettering Canc Ctr, New York, NY 10021 USA

[18] Univ Calif Los Angeles, Dept Radiat Oncol, David Geffen Sch Med, Los Angeles, CA 90024 USA

[19] Vrije Univ Brussel, Dept Radiotherapy, Brussels, Belgium

[20] Peter MacCallum Canc Ctr, Mol Imaging & Targeted Therapeut Lab, Melbourne, Vic, Australia

[21] Univ Coll London Hosp, Inst Nucl Med, London, England

[22] Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC USA

[23] Duke Univ, Sch Med, Dept Med, Durham, NC USA

[24] Vanderbilt Univ, Med Ctr, Div Hematol & Med Oncol, Nashville, TN USA

[25] Assoc British Pharmaceut Ind, London SW1A 2DY, England

[26] Univ London, Sch Pharm, London, England

[27] Int Chron Myeloid Leukemia Fdn, European Canc Patient Coalit & Chron Myeloid Leuk, Munich, Germany

[28] Susan G Komen Cure, Dallas, TX USA

[29] Univ Chicago, Dept Med, Chicago, IL 60637 USA

[30] Univ Chicago, Harris Sch, Chicago, IL 60637 USA

[31] Univ Oxford, Dept Clin Pharmacol, Oxford, England

[32] Clin Genolier, Genolier, Switzerland

来源：

LANCET ONCOLOGY | 2011年 / 12卷 / 10期

关键词：

CELL LUNG-CANCER; POSITRON-EMISSION-TOMOGRAPHY; RANDOMIZED PHASE-III; COST-EFFECTIVENESS ANALYSIS; STAGE BREAST-CANCER; HEALTH-TECHNOLOGY-ASSESSMENT; ERLOTINIB PLUS GEMCITABINE; ADVANCED PANCREATIC-CANCER; BODY RADIATION-THERAPY; CLINICAL-TRIALS;

D O I：

10.1016/S1470-2045(11)70141-3

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

The burden of cancer is growing, and the disease is becoming a major economic expenditure for all developed countries. In 2008, the worldwide cost of cancer due to premature death and disability (not including direct medical costs) was estimated to be US$895 billion. This is not simply due to an increase in absolute numbers, but also the rate of increase of expenditure on cancer. What are the drivers and solutions to the so-called cancer-cost curve in developed countries? How are we going to afford to deliver high quality and equitable care? Here, expert opinion from health-care professionals, policy makers, and cancer survivors has been gathered to address the barriers and solutions to delivering affordable cancer care. Although many of the drivers and themes are specific to a particular field-eg, the huge development costs for cancer medicines-there is strong concordance running through each contribution. Several drivers of cost, such as over-use, rapid expansion, and shortening life cycles of cancer technologies (such as medicines and imaging modalities), and the lack of suitable clinical research and integrated health economic studies, have converged with more defensive medical practice, a less informed regulatory system, a lack of evidence-based sociopolitical debate, and a declining degree of fairness for all patients with cancer. Urgent solutions range from re-engineering of the macroeconomic basis of cancer costs (eg, value-based approaches to bend the cost curve and allow cost-saving technologies), greater education of policy makers, and an informed and transparent regulatory system. A radical shift in cancer policy is also required. Political toleration of unfairness in access to affordable cancer treatment is unacceptable. The cancer profession and industry should take responsibility and not accept a substandard evidence base and an ethos of very small benefit at whatever cost; rather, we need delivery of fair prices and real value from new technologies.

引用

页码：933 / 980

页数：48

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