Journal of Clinical Oncology, Vol 16, 3900-3912, Copyright © 1998 by American Society of Clinical Oncology
Economic issues in lung cancer: a review
PJ Goodwin and FA Shepherd
Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada. pgoodwin@mtsinai.on.ca
PURPOSE: Lung cancer is a major source of morbidity, mortality, and health
care costs in the developed and developing world. It is estimated that lung
cancer is responsible for 20% of all cancer care costs. Concerns exist that
this expenditure is associated with questionable benefits. DESIGN: The
economic literature that relates to smoking was reviewed, followed by a
summary of the economics of the diagnosis, treatment, and palliation of
lung cancer. Methodologic considerations are also discussed in this
section. RESULTS: Published studies suggest that the increased lifetime
health care costs from smoking-related illnesses in smokers are partially
or fully offset by the higher medical costs that result from increased
longevity in nonsmokers. However, lost productivity costs, which result
from morbidity and early mortality among smokers, result in an overall net
cost of smoking to society. Discounting rates of 3% to 5% do not
substantively alter these results. The per-patient cost to treat lung
cancer is substantial. The major cost center is hospitalization; palliative
or terminal treatment is associated with significant costs. Savings can be
obtained through the judicious use of diagnostic and staging procedures.
Furthermore, combined modality treatment approaches and the palliative use
of combination chemotherapy appear to be associated with acceptable
cost-effectiveness compared with commonly used therapies for other
diseases. CONCLUSION: Although the increased medical care costs of treating
smoking-related diseases are somewhat offset by the higher medical care
costs due to increased longevity in nonsmokers, the lost productivity that
results from smoking results in a net cost to society. Standard approaches
to the management of lung cancer are associated with cost-effectiveness
similar to that of other commonly used medical interventions.
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