Monday December 12 2011
Could care at home alleviate soaring cancer costs?
“Cancer survival rates could fall because of a rise in the cost of diagnosis and treatment over the next 10 years,” the Daily Express warns today. Other papers, including the Daily Mail claim that treating patients at home instead of in hospital could stop cancer treatments from “bankrupting” the UK’s healthcare system.
The papers have each chosen to make stark warnings based on different aspects of the same report. The report, which projects the UK’s cancer treatment costs in 2021, was published by the private healthcare insurance company, Bupa.
The report calculates that last year 318,000 people in the UK were diagnosed with cancer, with an overall cost for cancer care of £9.4 billion across NHS, private and voluntary sectors. By 2021 the number of new cancer cases is predicted to rise to 383,000 per year at an increased cost of care of £15.3 billion. Bupa suggests that this increased need could be met by focusing on:
- improving patient understanding and treatment choice
- changing how and where cancer patients are cared for, including treatment at home
- making the most appropriate use of diagnostic techniques and treatments
What is the basis for these current reports?
The media stories are based on a Bupa report called ‘Cancer diagnosis and treatment: A 2021 projection’. The Bupa report discusses cancer incidence (rates of new diagnoses) in the UK and estimates how the incidence will change over the next 10 years. It also discusses current cancer care costs from both the NHS and private care perspective, and projects how costs may change in coming years, discussing challenges and possible solutions.
Bupa commissioned the private healthcare market research firm Laing and Buisson to establish the current cost of cancer diagnosis and treatment in the UK, and provide an estimate of costs in 2021. The predicted growth in cancer rates was calculated using the UK’s official population growth figures, set against current incidence rates for all ages. Current NHS spending was calculated using data from the Department of Health; private sector spending was estimated from Bupa data; and voluntary sector (hospice) spending was estimated using National Audit Office research.
The report focuses on cancer diagnosis and treatment costs and does not address other costs associated with cancer, such as medical research, support services, social care and lost work productivity from illness or premature death. The authors of this report claim its findings on cancer incidence are consistent with the projections of a recent report commissioned by Cancer Research UK that was published in the British Journal of Cancer.
The Bupa report also suggests ways to address the cost of cancer care. For example, it states that chemotherapy at home would save money because drugs administered in people’s own homes would be free of VAT (value-added tax), whereas the NHS has to pay VAT on drugs given in hospital. The report’s claims about chemotherapy at home are based on a review of effectiveness, safety and acceptability conducted by Bazian (the authors of this Behind the Headlines report) for Bupa. For more information, see further reading (below).
What does the report say about cancer rates?
The report states that, currently, cancer affects one in three of us during our lifetime. As increasing age is a risk factor for cancer, and the overall age of the population is increasing due to better healthcare and living standards for all, the incidence of cancer is predicted to continue to rise. The report says that there has already been a 28% increase in the number of new cancer diagnoses since the 1970s. The cancer most likely to affect men is prostate cancer (37,051 newly diagnosed cases in 2008), while women are most likely to be affected by breast cancer (47,693 newly diagnosed cases in 2008).
In the UK in 2010, 318,000 people were diagnosed with cancer. This is equivalent to one new case of cancer per 195 people per year. Ten years from now the increasing age of the population is expected to increase this figure by about 20% to 383,000 cases per year, which is equivalent to one new case of cancer per 175 people per year.
What does the report say about costs of cancer treatment?
Last year the costs of cancer diagnosis and treatment across the UK NHS, private and voluntary sector were estimated by the report at £9.4 billion. This is equivalent to an average of £30,000 per person with cancer. Of this total expenditure, 85% is funded by the NHS, 9% is funded privately and the remaining 4% is funded by the voluntary sector.
The report says that over the next decade the costs of cancer care in the UK are expected to rise to £15.3 billion in 2021, which is equivalent to an average of £40,000 per person with cancer. This will mean a 62% increase in the UK’s overall expenditure on cancer diagnosis and treatment, which is an increase of £5.9 billion compared with the current expenditure. By 2021, the NHS is predicted to need an extra budget of £5.2 billion to meet the need (a 65% increase on the current budget), the private sector will need an extra £531 million (also a 65% increase) and the voluntary sector will need an extra £131 million (a 22% increase). The increase in the voluntary sector is predicted to be lower than other sectors as it does not have the same technology and treatment costs as the other sectors.
Why is cancer care so expensive?
Just over a quarter of the current expenditure goes on hospital inpatient costs, not including surgery (just the cost of caring for a person in hospital). Almost a quarter (22%) goes on the cost of surgery, and 18% goes on drug treatments (including costs of giving the drug). The remainder of the budget goes on outpatient costs including diagnostic procedures (8%), radiotherapy treatment (5%), cancer screening (5%), specialist services, such as palliative care (5%), and other community services including general practice care (10%).
Cancer care may incur many added costs, including those of medical advances such as advanced imaging techniques, keyhole surgical techniques and targeted radiotherapy. These may be more expensive but can help to ensure that treatment targets cancer tissue and causes minimal damage to surrounding healthy tissues. Developing new types of drugs is also likely to add to costs.
Over the past seven or eight years newer technologies have been estimated to add around 3.7% per year to the total cancer expenditure. This rate of increase is expected to apply in the coming decade as well.
What suggestions does the report make for meeting these challenges?
As the Bupa report states, there are ultimately only three ways to pay for healthcare. These are tax, insurance or cash. The report warns that if we do not address the rising costs, then we will not be able to meet the level of diagnosis and treatment required over the next 10 years and beyond.
The report concludes that, as well as paying more for cancer care, the UK needs to make the best use of resources it already has, including:
- making it easier for people to understand cancer treatment options
- changing how and where cancer is treated
- finding new ways to address diagnostic and treatment costs
To address these issues, the Bupa report suggests that:
- National planning for availability of new drugs and technologies is improved. This includes establishing care guidelines and planning how new tests and treatments will be introduced and how they will be priced most effectively.
- ‘Companion diagnostic tests’ are introduced appropriately to test whether a person’s cancer is suitable for treatment with a particular drug (‘personalised medicine’).
- New ways to fund the development of cancer drugs are found.
- Out-of-hospital care (such as chemotherapy at home) becomes a standard choice for patients when clinically appropriate.
- People are allowed to manage their own follow-up appointments, so that they are tailored to their needs, rather than just setting appointments at regular intervals.
- People are helped to ‘navigate’ their cancer treatment options, in particular, enabling patients to transfer their care between public and private facilities more easily.
The Bupa report says that cancer charities already carry out a highly beneficial role and will continue to do so, helping people to understand their cancer and its treatment better, to enable them to make more informed decisions. It suggests that public education to guide healthy lifestyle choices can also help to improve population health and may, in time, go towards reducing the disease burden.
Finally, the Bupa report also calls for a concerted effort to improve access to quality care for everyone affected by cancer.