The cost of cancer

In the last 30 years medical science has developed an array of new technologies such as cell cytology, radio-isotopic scanning, soft tissue X-rays (mammography and computerized tomography), etc., which have potential for the early detection of cancer, and when coupled with current or future therapeutic techniques may lead to improved rates of cure or prolonged survival of patients with cancer. Whenever preliminary evidence of efficacy is developed, considerable public pressure mounts both within and outside the medical community to implement screening programs on a widespread basis. Advances in screening and treatment, however, are coming at a time when there is serious nationwide concern over the total amount now being spent for health care in the nation and the rate of inflation that has occurred almost every year. In the medical literature, the little existing identification of the costs and economic benefits of screening (and of disease control programs in general) is often presented in a fairly simplistic fashion. Yet, just as many of the biologic issues in cancer screening are complex, so too are the economic ones. This paper will begin to identify: 1. the economic approaches to evaluating screening, 2. the problems in specifying costs, 3. the issues involved in selecting benefit measures, and 4. how these interact in the formulation of screening policies. In addressing these issues, new data on cost of cancer treatment, based on the third National Cancer Survey, will be presented. These data include hospital and nonhospital costs, disaggregated by source, cancer site and stage.