Crit­ics pounce

Ex­perts cite old data, met­rics in can­cer costs study

Modern Healthcare - - THE WEEK IN HEALTHCARE - Mau­reen Mckin­ney

Amid wor­ries over bal­loon­ing health­care costs and in­fe­rior care, a study ar­gues that the na­tion’s high lev­els of can­cer spend­ing ac­tu­ally lead to bet­ter out­comes for U.S. pa­tients when com­pared with their Euro­pean coun­ter­parts.

Ex­perts in can­cer and health­care spend­ing, how­ever, were quick to find flaw with the study, crit­i­ciz­ing the re­searchers’ choice of met­rics and their reliance on older data.

“I find it to be pretty dif­fi­cult to un­der­stand,” Martin Brown, a health econ­o­mist and chief of the Na­tional Can­cer In­sti­tute’s Health Ser­vices and Eco­nom­ics Branch, said of the ar­ti­cle. “There seems to be a

VIDEO lot of stuff go­ing on in the back­ground and a lot of as­sump­tions be­ing made.” For the study, which ap­peared in the April is­sue of Health Af­fairs, re­searchers from the Univer­sity of Chicago and the Univer­sity of South­ern Cal­i­for­nia used can­cer reg­istry data span­ning from 1983 through 1999 to es­ti­mate can­cer sur­vival rates. Us­ing dol­lar value es­ti­mates of ad­di­tional years of life, they then cal­cu­lated whether the ad­di­tional life ex­pectancy of Amer­i­can pa­tients was worth the ex­tra money—$72.1 bil­lion in 2004—that is spent on can­cer care in the U.S.

“Us­ing con­ser­va­tive mar­ket es­ti­mates of the value of a sta­tis­ti­cal life, this study pre­sented ev­i­dence that U.S. can­cer sur­vival gains are worth more than the cor­re­spond­ing growth in the cost of U.S. can­cer care ac­cord­ing to the most re­cent data avail­able for anal­y­sis, 198399,” wrote the au­thors, who were led by To­mas Philip­son, a public pol­icy pro­fes­sor at the Univer­sity of Chicago and a vis­it­ing scholar at the Amer­i­can En­ter­prise In­sti­tute.

But Brown, who au­thored one of the data sources cited in the study, ar­gues there are other, more cur­rent sources of in­for­ma­tion avail­able. Many of the most ex­pen­sive can­cer treat­ments in use have emerged since 1999, he says, and the study does not take those into ac­count.

Sur­vival rates, or the time from di­ag­no­sis un­til death, are a met­ric that most epi­demi­ol­o­gists deem to be an in­ap­pro­pri­ate mea­sure of out­comes, Brown added. That’s es­pe­cially true be­cause the U.S. has dra­mat­i­cally in­creased rates of screen­ing for many types of can­cer, which has im­proved early de­tec­tion and there­fore likely in­tro­duced “lead-time bias,” he said.

“It’s a very com­plex thing they’re try­ing to do and I think they have started, but there are a lot of ques­tions that still need to be looked at,” he said. “And an up­date with more con­tem­po­rary data would be of great in­ter­est.”

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