Cancer economics, policy and politics: What informs the debate? Perspectives from the EU, Canada and US

In high-income countries the public policy consensus is that costs of delivering high-quality equitable cancer care present an increasing challenge to national budgets. In the U.S. alone it is estimated cancer care expenditures in 2020 will be 157 billion dollars. The increase is being driven by a number of factors including technological innovation, rising costs of medical and hospital care, expensive therapeutics and an increase in the proportion of individuals susceptible to malignancy as the population ages. In this article we review what factors are informing and influencing the political debate on cancer economics across Europe and North America.We have undertaken a comprehensive analysis of the literature and supplemented this with key informant interviews within each region. An important theme is the increasing role of individual patients, organisations and physicians in advocating for greater access to and fairer prices for cancer therapies. Whilst health technology assessments (HTAs) are increasingly prevalent their role in informing reimbursement policy is influenced by public and political scrutiny, which impacts their ability to ensure access to high value cost effective care. Austerity measures following the global recession have created inequities in access to drugs with concern about the impact on subsequent outcomes. The cancer economics debate has largely centred on the provision of drugs, with access to radiotherapy and over-penetration of high cost radiation technologies under-represented in media outputs and political discussion.Future work should enhance collaborative efforts to assess relative effectiveness and to provide real-world data. These debates are becoming increasingly complex, even as we face stagnating health budgets. We must also be aware of the key factors that play a significant role in cancer policy aside from economics including socio-cultural values, advocacy and political influence at the country and regional level.