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While the U.S. may spend about twice as much on cancer care as the average high-income country, its cancer mortality rates are only slightly better than average, researchers found.

In a cross-sectional study of 22 countries, the median per capita spending for cancer care was $296 -- with the U.S. spending more than any other country, at $584, reported Cary P. Gross, MD, of the Yale School of Medicine in New Haven, Connecticut, and colleagues.

Meanwhile, the U.S. cancer mortality rate was 86.3 per 100,000 compared with 91.4 per 100,000 for the entire study cohort, they noted in .

"The U.S. is spending over $200 billion per year on cancer care -- roughly $600 per person, in comparison to the average of $300 per person across other high-income countries," said Gross in a press release. "This raises the key question: Are we getting our money's worth?"

While the U.S. had the highest median per capita spending, the lowest median spending was found in Spain ($132), Finland ($179), and Italy ($195).

Cancer care accounted for 6.0% of total healthcare spending overall, with the lowest percentage in Sweden (3.7%) and the highest in Korea (9.6%). The rate in the U.S. was 5.33%. However, total health costs per capita were significantly higher in the U.S. ($10,945) compared with any other country.

Gross and colleagues noted that the U.S. cancer mortality rate was higher than the rate for six other countries -- Finland (84.3 per 100,000), Iceland (84), Australia (83.3), Switzerland (83.3), Japan (81.5), and Korea (75.5).

"Notably, several countries had both lower expenditures and lower cancer mortality rates than the U.S.," they wrote, specifically Australia, Finland, Iceland, Japan, Korea, Luxembourg, Norway, Spain, and Switzerland.

Compared with the remaining countries with higher cancer mortality rates, the U.S. spent more than $1 million per averted cancer death, they noted.

"Adjusting for differences in smoking rates shows that U.S. cancer care had less favorable outcomes than suggested by unadjusted mortality rates, as historically lower smoking rates in the U.S. had been protective against cancer mortality," the authors observed.

They also found that cancer care expenditures were not associated with cancer mortality rates, with or without adjustment for smoking (Pearson R = -0.05, 95% CI -0.46 to 0.38, P=0.81; and R = -0.05, 95% CI -0.46 to 0.38, P=0.82).

Why, then, is cancer care so expensive in the U.S. relative to mortality benefits?

"To place our results in context, the factors associated with the high cost of U.S. cancer care must be considered," Gross and team wrote. "Cancer drug expenditures account for 37% of privately insured U.S. cancer expenditures, and U.S. cancer drug costs are greater than those of other countries. Prices for the same medications are higher in the U.S., and cancer drugs frequently increase in price after their initial launch. This phenomenon stems from the inability of Medicare to negotiate pricing, along with state laws mandating insurers to cover all approved cancer drugs regardless of cost."

They also noted that regulatory processes in the U.S. facilitate earlier access to expensive new drugs, such as monoclonal antibodies, kinase inhibitors, and immune checkpoint inhibitors, "which often confer marginal or unclear survival gains." Furthermore, end-of-life cancer care in the U.S. is resource-intensive and expensive, they added.

"Understanding how other countries achieve lower cancer mortality rates at a fraction of U.S. spending may prove useful to future researchers, clinicians, and policy makers seeking to best serve their populations," they concluded.

For this study, which was conducted from September 2021 to March 2022, countries were included if they met four criteria:

• Had a very high Human Development Index, a measure of a country's status in several dimensions of human development
• Were in the top 30 countries based on gross national income per capita
• Had 2020 cancer mortality rate estimates
• Had recent estimates (after 2010) for the percentage of healthcare expenditures dedicated to cancer care

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