Compared to Similar Countries, U.S. Cancer Care Spending High Without Low Mortality

In comparison to 21 other high-income countries, the United States spends more on cancer care but does not have the best cancer outcomes, a new research article shows.

The United States spends more on healthcare than any other country. Despite the high level of U.S. healthcare spending, the country lags behind other high-income countries in several health outcomes such as maternal mortality.

The new research article, which was published by JAMA Health Forum, compares U.S. cancer care spending and mortality rates to 21 other countries in the Organisation for Economic Co-operation and Development in 2020. The study includes three key data points.

• The median cancer mortality rate was 91.4 per 100 000 population. The U.S. cancer mortality rate (86.3 per 100 000) was higher than that of six other countries.
   
• Median per capita spending for cancer care was $296. U.S. per capita spending for cancer care was $584, which was higher than any other country.
   
• Smoking is a strong factor associated with cancer incidence, and the United States has a relatively low smoking rate. When adjusting for smoking rates, nine countries had lower cancer care spending and lower mortality rates than the United States.

"In this cross-sectional study of 22 high-income countries, cancer care spending was not associated with age-standardized cancer mortality rates. Although the U.S. spent more on cancer care than any other country, this expenditure was not associated with substantially lower cancer mortality rates. Understanding how other countries achieve lower cancer mortality rates at a fraction of U.S. spending may prove useful to future researchers, clinicians, and policy makers seeking to best serve their populations," the research article's co-authors wrote.

The study's findings provide more evidence that the United States does not generate high value from the country's high health care spending, co-author Elizabeth Bradley, president of Vassar College and a professor of science, technology, and society, said in a prepared statement. "The pattern of spending more and getting less is well-documented in the U.S. healthcare system; now we see it in cancer care, too. Other countries and systems have much to teach the U.S. if we could be open to change."

Factors driving U.S. cancer care spending

Several factors account for why U.S. cancer care spending is higher than that found in other countries, according to the research article.

• The United States spends more than other countries on cancer drugs
   
• The prices of U.S. cancer drugs are relatively high, particularly for new drugs
   
• The U.S. Food and Drug Administration grants earlier and wider access to new drugs compared with other countries' regulatory agencies
   
• Inappropriate cancer screening has been reported
   
• U.S. cancer care includes interventions for low-risk tumors such as early-stage prostate cancer, which is unlikely to cause harm if left untreated
   
• End-of-life care in the United States is relatively intensive compared to other countries, with one study finding that U.S. cancer patients are admitted to intensive care units at twice the rate found for cancer patients in six other developed countries