March 20th, 2015
In a recent paper, Soneji and Yang revisit a topic we first explored in the April 2012 issue of Health Affairs — namely, whether the U.S. gets value for its cancer care. We found that life expectancy after cancer diagnosis rose more quickly for patients in the U.S. than for patients in Europe. Moreover, while spending per patient also rose more quickly in the U.S., Americans still received good value from the health care system. Compared to the gains seen in Europe, for example, each additional life-year gained in the U.S. cost roughly $20,000 in additional U.S. spending.
Soneji and Yang re-examine trends in cancer deaths in the U.S. and Europe and draw different conclusions. While we welcome the attention paid to this important issue, Soneji and Yang’s conclusions rest on fundamental flaws in their own approach and a misunderstanding of the methods we use in our study.
To understand the value of U.S. cancer care, one must ask whether the health care system performs better for U.S. cancer patients than those of other countries and at what cost. In attempting to answer this question, Soneji and Yang ask whether more people die from cancer in the U.S. or in Europe. This isn’t the right question. The total number of people dying from cancer is a misleading indicator of health system performance. Factors like poverty, pollution, smoking, diet, and exercise all contribute to the number of people acquiring cancer and dying from it, and confound the effects of cancer treatments. The bottom line is that mortality reflects treatment, but it also reflects the number of people who get cancer.Read the rest of this entry »