The first ever study to evaluate the cost of cancer in Europe has found that the disease cost €126 billion in 2009.
That is the total economic cost of cancer across the 27 countries of the EU, researchers from Oxford University and King's College London report. Cancer in Germany, France, Italy, and the UK together accounted for just over two-thirds of the cost.
The calculation included the cost of healthcare for cancer (including the cost of drugs), the cost of productivity losses (due to premature death, and people being unable to work due to illness), and the cost of informal care from friends and relatives.
Around two-fifths (€51 billion) of this cost was incurred by healthcare systems, with the rest incurred by patients' families, friends, and society overall. Friends and relatives of people with cancer were estimated to have provided 3 billion hours of unpaid care overall.
The total cost of cancer in the UK was £12.2 billion, or just under £200 per person. Healthcare costs accounted for £4.4 billion of this total.
'When we compare the UK to other similar countries (in terms of GDP per capita), the UK's spend on cancer care does not appear to be disproportionate,' said Dr Ramon Luengo-Fernandez of the Health Economics Research Centre at the University of Oxford.
The results, published in the journal Lancet Oncology, reveal substantial disparities between different countries in the EU in spending on healthcare and drugs for cancer. Luxembourg and Germany spent the most on healthcare for cancer per person, with Bulgaria spending the least.
'The main driver of cancer-related healthcare costs is a nation's wealth,' said Dr Luengo-Fernandez. 'In general, wealthier countries tend to spend more, both in absolute and relative terms (ie as a proportion of their GDP), on healthcare and subsequently on cancer care.
'Other reasons are varied. Some countries rely heavily on inpatient services to provide cancer care while others resort more to the outpatient services, which are in most cases considerably less costly. Further research is required, however, to better understand the reasons behind the differences identified in our research.'
The researchers also examined the different contribution of four cancers – breast cancer, bowel cancer, lung cancer and prostate cancer – which in the EU contribute to around half of all new cancer diagnoses and deaths. Lung cancer had the highest overall cost at €18.8 billion and was also responsible for the biggest loss of productivity. Healthcare costs were highest for breast cancer at €6.7 billion, largely due to a high rates of spending on drugs for this illness.
The researchers point out that these estimates are conservative, as some categories of healthcare costs, such as screening programmes, were not included due to the inability to obtain these data for all countries under study.
Professor Richard Sullivan from King's College London, one of the co-authors of the study, said: 'It is vital that decision-makers across Europe use this information to identify and prioritise key areas. More effective targeting of investment may prevent health care systems from reaching breaking point – a real danger given the increasing burden of cancer – and in some countries better allocation of funding could even improve survival rates.'
Dr Luengo-Fernandez agrees: 'Our results show wide differences between countries in the costs of cancer, both for healthcare systems and society overall. The reasons for these differences require further investigation. For example, why do comparable countries spend far more than others for cancer care?
'Careful assessment of costs, how care is structured and delivered, and an assessment of whether the treatments and care provided by a healthcare system are "good value for money", as recommended by the National Institute for Health and Care Excellence (NICE), will improve the move towards evidence-based care in the EU and improve the overall care and well-being of patients.'
Previously, the same researchers estimated the economic burden of heart disease and stroke. While the cost of cardiovascular disease in the EU is higher than that for cancer (€195 billion versus €126 billion), the higher number of cancer-related deaths in people of working age means the cost of productivity losses due to premature death was nearly twice as high for cancer as that for heart disease (€43 billion versus €27 billion).
The group has also estimated the total economic cost for dementia for 15 European countries (those that were members of the EU before 2004), arriving at a figure of €189 billion. For the same 15 countries, the economic burden of cancer is €117 billion.
'Although we found healthcare costs for cancer to be considerably higher than those for dementia (almost five times higher),' said Dr Luengo-Fernandez, 'the burden on unpaid carers of individuals with dementia far outweighed that for cancer (€129 billion versus €22 billion, respectively).'