Economics of Cancer Research Group
Research - Dissemination - Collaboration
Research - Dissemination - Collaboration
The Incidental Economist
Institute of Cancer Policy
MacMillan Cancer Information Blog
Health chatter: The Health Behaviour Research Centre Blog - UCL
Partners in Health Blog
The Health Care Blog
Timothy McBride Blog on Health Care
Health Policy insight
Sterling Behavioral Science Blog
Wonkblog Health Care
Nuffield Trust Blog
NCPA's Health Policy Blog
Health Affairs Blog
Economics of Cancer News
June 29, 2015
Estimating the economic burden of cost associated with blood cancer in 31 European countries
At the European Hematology Association (EHA) annual conference in Vienna (June 11th-14th), I presented the findings of a recent cost of illness study with project collaborators Dr. Ramón Luengo-Fernández and Dr. Jose Leal, both colleagues from the Health Economic Research Centre (HERC), University of Oxford. HERC was funded by the EHA to estimate the economic burden of blood cancers (ICD- C81-C96 and D47) and blood disorders (ICD- D50-D89) across the EU-28 and Iceland, Norway and Switzerland. Blood disorders have a high impact on the population, with 1.6 billion people in the world affected by anaemia alone; therefore, representing a substantial economic burden. However, this analysis was the first systematic cost-of-illness study to assess the economic impact of blood cancers and blood disorders across Europe.
Costs were evaluated from a societal perspective, and included: healthcare, informal care, and productivity costs due to illness and premature death adopting a top-down approach. Costs of blood cancers were compared to the overall costs associated with cancer across Europe as reported in previous work by Luengo-Fernández et al (2013).  A range of sources were used to estimate resource use and costs including: WHO, OECD Health data, EUROSTAT, SHARE Database, national ministries, national statistical institutes, and published studies. Costs were assessed over an annual timeframe and reported in 2012 Euros (€).
Focusing on blood cancers only, we estimated that the economic burden in 2012 was €12 billion. Healthcare costs accounted for €7 billion (61%) of the total economic burden, whilst productivity losses due to early mortality and absence from work accounted for 31% of costs (€4 billion). The remaining €1 billion (8%) were due to informal care costs. In the EU countries, blood cancers accounted for 12% (€6.7 billion) of total healthcare expenditure on cancer (€57 billion), with this proportion being second only to breast cancer. In terms of total costs, blood cancers accounted for 8% (€11 billion) of total cancer costs (€143 billion) within EU countries. Therefore, blood cancers represent a leading cause of death, healthcare service use and costs, not only to European healthcare systems but to society overall. The results presented at EHA add to essential public health knowledge required for effective delivery and allocation of care resources and public research funding.
Graph 1 above highlights the healthcare costs per 10 people in the population associated with blood disorders.
Table 1 highlights cost comparisons with all cancers for the EU countries across the different elements of costs.
Table 2 highlights healthcare costs and total cost rankings across types of cancer for the EU countries. The analyses undertaken will be submitted for publication in the coming months. For further details contact:
Thanks for reading,
 European Hematology Association 20th Congress “EHA Advocacy Session: Hematology Awareness: Research Roadmap/Cost of Blood Disorders.” June 13th 2015, Vienna, Austria http://www.ehaweb.org/congress-and-events/20th-congress/program/program-by-track/
 Luengo-Fernandez R, Leal J, Gray A. Sullivan R. (2013) “Economic burden of cancer across the European Union: a population-based cost analysis.” Lancet Oncology; 14(2): 1165-1174
May 27, 2015
As Professor Azeem Majeed has illustrated on Twitter, cancers (malignant neoplasms) are now the most common cause of preventable deaths in England and Wales. The figure below, which is from the ONS Statistical Bulletin on avoidable mortality in England and Wales, shows that since 2007, cancer has overtaken cardiovascular disease as the most common cause of preventable death.
About 23% of deaths registered in England and Wales were considered "avoidable through good quality healthcare or wider public health interventions". Lung cancer alone accounted for 15% and 16% of avoidable deaths among men and women respectively.
The bulletin offers a range of other important information as well as raw excel data for researchers.
May 25, 2015
The National Cancer Institute have put together an excellent time diary of milestones in cancer research in the last 250 years which can be found here. It is clear that many of the cancer prevention and treatment breakthroughs are quite modern and their has been a large increase in the pace of breakthroughs, especially since 1990.
May 23, 2015
Professor Lieven Annemans speaking on Health Economics in Cancer at the European Society for Medical Oncology.
May 22, 2015
The National Cancer Institute runs PostDoctoral Fellowships in the area of Cancer Prevention each year. This year's call has been posted (see here). The fellowship runs for 4 years and involves gaining an MPH in year one at one of a excellent university in the US.
These fellowships of researchers the opportunity to work at the largest cancer research institute in the world. In 2014, ECRG member Dr Diarmuid Coughlan was awarded a Fellowship which he will take up this summer.
For cancer researchers in Ireland, there is a additional potential of applying for one of these fellowships through the Ireland-Northern Ireland Cancer Consortium. See additional requirements here.
May 11, 2015
We would like to bring to your attention two upcoming conferences (in Newcastle and Paris) which will focus on the economic impact of cancer on workers and labour market outcomes.
On 9th July 2015 at Newcastle University (map of venue: https://goo.gl/KR1Icm) a conference will take place entitled: Social Science Perspectives on the Working Lives of Those with Cancer: Psychosocial, Organisational and Economic Perspectives. The Economics of Cancer.
This conference is organised by Dr Heather Brown (Newcastle University) and others from Birkbeck University and the University of Aberdeen and is funded by the ESRC. The conference will focus on the economic impact of cancer on workers and speakers include Dr Brendan Walsh from the ECRG (speaking on the economic burden of cancer in England) and Prof Linda Sharp Newcastle University. To register for this event please email firstname.lastname@example.org. A full programme can be found below (click on image to enlarge).
A second conference will take place in Paris on 28th-29th September 2015 at FIAP Jean Monnet, 30 rue Cabanis - 75014 PARIS (map: http://www.fiap.asso.fr/plan-d-acces.html).
This conference is organised by the Centre d’études de l’emploi (CEE), the Institut de recherche et documentation en économie de la santé (Irdes) and the Équipe de recherche sur l’utilisation des données individuelles en lien avec la théorie économique (Érudite - Université Paris-Est) and will feature a number of renowned speakers on cancer and labour outcomes including Prof Cathy Bradley (Virginia Commonwealth University), Prof Thomas Barnay (CREAM, Université de Rouen, Erudite and TEPP) and Dr Joseph Lanfranchi (Lemma, Université Panthéon-Assas and Centre d’études de l’emploi).
The conference has a call for papers (see below & http://www.cee-recherche.fr/toutes-les-actualites/appel-contributions-call-papers). Email abstracts/papers to email@example.com. A programme for this conference and a quick outline of the conference can be found below (click on image to enlarge).
April 27, 2015
Health economics studies have the ability to allow policymakers to understand how much is actually spent on cancer including (including a study being undertaken by members of the ECRG at City University London on the costs of cancer in England) and to allow for cost-effective cancer care to be used. The latest issue of Health Affairs* features a number of research papers on the "Cost and Quality of Cancer Care" which are advised reading for anybody interested in the economics of cancer, this issue offers up a number of important and interesting topics in the area. The growth in the cost of cancer care, along with other health care costs, is unlikely to continue at the rate it has in the past. This is going to have considerable impacts cancer care in developed countries going forward and these studies highlight a number of issues which may be affecting the cost of cancer care.
Editor in Chief of Health Affairs, Alan Weil leads of the issue with some excellent points on the cost of cancer care (see here, ungated, available to all).
Papers (gated for many unfortunately) in the issue explore amongst other topics:
Another study estimate the expenditure in the US on false-positive breast cancer screening and on overdiagnosis from mammography to be ~$4 billion annually. While there is no doubt that two big issues in cancer screening, and breast cancer screening in particular, are overdiagnosing cancers which would not have developed to the extent that they would affect the individual, it is quite difficult to determine a if a breast cancer has been overdiagnosed and therefore to put a potential cost on this. But the correct use of screening whereby the benefits and harms of the screen are weighed up, those individuals who would most likely benefit from screening, and preventing too regular screening is likely to reduce costs both to those undertaking the screen and the health care system.
* Click on the highlighted Blue words to be taken to the articles.
March 18, 2015
Cancer Research UK (via Twitter) have presented an excellent graph highlighting both the absolute and relative probability of cancer for women in different weight categories. Often the relative increase in risk (in this case 41%) is often misinterpreted by both clinicians and the public. This graph provides an excellent ways of communicating risk.
In the past TheIncidentalEconomist have blogged about the inappropriate use of relative risk only in conveying information to the public (see here, and here).
March 12, 2015
The Canadian Centre for Applied Research and in Cancer Control have announced The ARCC Conference 2015 will take place in Montreal from 24-25 May 2015. Further information may be found here. To view presentations from previous conferences please visit the ARCC website.
February 18, 2015
Delivering Affordable Cancer Care
The World Innovation Summit for Health #WISH2015 is currently being held in Qatar. One of the most important sessions on "Delivering Affordable Cancer Care" can be viewed on their webpage.
The video provides an excellent insight into many of the issues of cancer in the future especially relating to the economic burden of the disease, value in cancer care and changing the culture of cancer care.
Speakers in the session include Professor Robert Thomas, Department of Health, Australia and Dr Otis Brawley, American Cancer Society (Dr Brawley previously gave a seminar to economicsofcancer.com which can be seen here).
A full transcript of the WISH report can be downloaded from the WISH webpage.
February 11, 2015
Enthusiasm for Cancer Screening Must be Combined with Correct Screening Use!
A new study (see abstract below) by researchers at the Health and Behaviour Research Centre, University College London and Cancer Research UK that appears in the British Journal of Cancer (see here; free to access) highlights that the vast majority of Britons are enthusiastic for cancer screening. However, this greater enthusiasm may encourage screening to regularly or the use of screening tests that may not be appropriate for the individual.
In Ecancer.com's accompanying commentary, one of the author's of the study, Dr Jo Waller (who has published numerous studies on cancer screening - see her publication profile here) also makes an important remark about screening being an individual decision:
“It's great that people are enthusiastic about cancer screening, and if people are keen to be screened, we need to minimise any barriers. But it’s also important to remember that taking part in screening is an individual choice, and if someone decides that screening is not for them after considering the benefits and harms then that choice should be respected.”
Cancer screening can be an extremely effective tool to prevent cancer or detect cancer in its earliest stage, thereby reducing mortality and increasing survival. However, like many forms of healthcare, the decision to screen should take account of both harms and benefits to the individual both by the individual themselves and also their doctor, or in many cases the screening regulatory body. While some harms may be seen as minor such as discomfort or anxiety many potential harms include unnecessary or over treatment of a cancer cancer which may never affect the individual. Where evidence points to screening being ineffective for some individuals, or where overuse of screening may increase potential harms. Also ineffective screening of individuals increases costs to the individual and the State. Cervical cancer screening in the US and the Netherlands for instance have both had the same impact upon cancer mortality however the programme in the US costs 4 times more due to the regularity of screening (Habbema et al. 2012). Much of these extra costs (an inequalities in utilisation) can be blamed upon the lack of organised screening programmes in the US (Smith & Brawley, 2014).
In Britain and elsewhere in Europe, considerable investment by policymakers and researchers has been made to identify those cancer where the benefits of screening far outweigh harms of the procedure (cervical cancer screening, breast cancer screening among those aged over 50 and colorectal cancer screening for those aged over screening - EU Council Recommendations). Organised population-based screening programmes are effective in inviting targeted individuals who will benefit most from screens. These programmes have aided the reduction in mortality from certain cancers. Where the evidence remains ambiguous or screening is ineffective, no such programmes exist, however some individuals continue to screen (PSA testing for prostate cancer among older and younger men for example). Where population-based programmes do not exist (in the United States), there is less of by national screening programmes the decision to screen remains falls on the individual and their doctor.
Members of the Economic of Cancer Research Group have published a number of studies in various areas of cancer screening (see our publications here). Some of these studies have highlighted that screening utilisation is extremely high amongst some groups where the benefits of screening may not out weigh the harms for example PSA screening for prostate cancer among older and younger men in Ireland and over screening among some women for cervical cancer screening in the United States (forthcoming paper in the American Journal of Managed Care).
Overall greater knowledge and enthusiasm for cancer screening can only be welcomed. However, it is the duty of policymakers, researchers and doctors to better inform individuals about what screens are appropriate for them based upon evidence, and to afford all individuals the best opportunity to access screening (and speedy diagnostics and treatment if necessary).
January 08, 2015
Of the various Health Literacy definitions, the Institute of Medicine (IOM) is probably the most widely cited one in the research literature. The IOM define health literacy as ‘the ability to obtain, read, understand and use healthcare information to make appropriate health decisions and follow instructions for treatment’. I maintain that a bit like health economics, health literacy is ubiquitous in our everyday lives. Moreover, there is an important overlap. To avoid market failure, health information must be understood and acted upon appropriately by the general public. This is especially true in cancer communication where poor health literacy can have fatal consequences.
An example that comes to mind is of hearing the tragic news of how a friend of a friend died from testicular cancer that had metastasised. He felt a lump on his testicle but was unaware of the seriousness of his complaint and unfortunately did not visit his primary care doctor until it was too late. For me, he died not from cancer but from ignorance. The same can be said of Jade Goody and her death from cervical cancer. The field of health promotion is often about combating ignorance. A study in the International Business Times showed that an Ignorance Index reveals that Italians are the most oblivious about social issues and demographic trends. I think it would be interesting to repeat this international comparison in knowledge of cancer causes, symptoms and prevention methods. One of the most misconstrued cancer prevention strategies has been the HPV vaccine.
The most recent published data of uptake of the 3-dose HPV vaccination among 12-year old girls in countries like Australia(71%), Ireland(84.2%) and England(86%) is in stark contrast to the United States(34% for full coverage). There is a multitude of reasons why this is so including government sponsorship of school-wide vaccination programs. But also, a recent systematic review of studies (mostly conducted in the U.S.) examining correlates of HPV vaccine uptake in teenage girls identified the following personal cognitive factors: having higher vaccine-related knowledge, having a healthcare provider as a source of information and maintaining positive vaccine attitudes. Therefore, the authors concluded that interventions that improved understanding of and positive attitudes towards HPV vaccine may increase HPV vaccination coverage. However, a systematic review of 33 educational intervention studies did not show strong evidence to recommend any specific educational intervention for wide-spread implementation. Now that HPV vaccination is recommended for boys, how should policy-makers promote uptake of the vaccine? What they should not do is adopt the National Football League (NFL) philosophy of providing simplified advice or what some have labelled as ‘misinformation’.
NFL Annual Mammography Campaign
An article in The Guardian highlighted this story. Every October, the NFL’s promote breast cancer awareness by broadcasting that ‘annual screening saves lives’.
This is what the American Cancer Society promotes too (A Wall St. Journal article also asks the question - Is annual mammography good value for money?). However, this is at odds with the U.S. Preventive Services Task Force recommendations for breast cancer screening. Moreover, the National Cancer Institute is more pragmatic about their recommendation that women over 40 years of age should discuss with their physician, given the uncertainty about mammography. From this health literacy researcher perspective the simplified message doesn’t help women to understand the risks and benefits of mammography for women to make an informed decision. A sentiment echoed in the following quote from the journalist (Karuna Jaggar) that wrote the NFL piece: “Oversimplified messages and widespread falsehoods like the NFL’s can lead many women in the US to overestimate their risk of breast cancer, overestimate the benefit of mammograms and underestimate the harms from routine screening. Inaccuracies like the NFL’s manipulate women’s emotions through fear-mongering and false promises”.
Attention to Communication
So, when it comes to promoting cancer prevention and care, advocating that particular attention be given to ‘cancer literacy’ seems important to me. The economist in me, asks the question what is the most efficient way to promote ‘cancer literacy’ that represents the most value-for-money? My opinion is that traditional mediums such as billboards, TV and print advertisement are likely to be expensive, lack market penetration and allow only for over-simplified slogans. The modern battleground for getting the message out there is all about engaging with the public using social media. This platform allows for the salient information to be communicated and engaged with by the general public.
Social Media in Cancer Prevention
So, back to how to promote the use of the HPV vaccine – well there are government websites such as those in Australia that are easy to navigate for students, parents and other stakeholders. But the main digital battleground is played out YouTube, Facebook and Twitter that have user-engagement. There are many videos spuriously advocating against HPV vaccine that have lots of views and comments. In comparison, relatively few videos promote in favour of HPV use - My favourite is from Dr. Aaron Carroll(co-editor of the excellent blog The Incidental Economist) at Healthcare Triage. The question that I pose is whether digital dissemination of information by public sector health authorities is utilised enough in helping the general public make decisions on cancer prevention strategies?
Along with videos, infographics are great ways of promoting ‘cancer literacy’. In general, I really like the American Institute for Cancer Research prevention infographics. For HPV vaccination, I really like the CDC’s infographic. These are important tools to use when it comes to the Twitter world. Research has shown that negative messages spread faster than positive ones and they say a picture tells a thousand words which are more than the 140 characteristics allowed on Twitter.
The bottom-line of this blogpost is that once the scientific/medical community are certain that a cancer prevention strategy is effective and then cost-effective, stakeholders must invest appropriate and sustained attention to dissemination of information to improve cancer literacy. Availing of social media allows for improved understanding, is relatively cheap and is very effective.
November 26, 2014
A new paper led by researchers in IARC has been published in Lancet Oncology. The paper entitled "Global burden of cancer attributable to high body-mass index in 2012: a population-based study" has estimated the global burden of cancer attributable to high BMI in 2012.
The study found that 3.6% of all new cancers globally were attributable to high BMI. BMI was a bigger predictor of cancer in those countries with higher HDI (Human Development Indices - an index used to characterize the most developed countries). As expected colorectal cancer was one of the main cancers attributable to high BMI, but somewhat surprisingly, cancer of the uterus and postmenopausal breast cancer were also two of the main cancers most attributable to high BMI.
The study highlights the how the cancers attributable to high BMI differs worldwide and is most prominant in higher income (higher HDI) countries.
Professor Richard Sullivan at the Institute of Cancer Policy has an accompanying piece discussing the results here. Some other commentary on the piece can be found at Lancet Oncology, LA Times and the authors themselves at the World Cancer Research Fund International.
November 13, 2014
Yesterday, researchers from the American Cancer Society published an important study on Inequalities in Premature Death From Colorectal Cancer by State in the United States. A copy of the paper can be found here (abstract included below).There are some excellent commentaries on this paper by the Institute of Cancer Policy & Sciencedaily.
This piece investigated colorectal deaths among 25-64 year olds in the US. It was shown that mortality rates were far greater among lower socioeconomic individuals (measured as low educational attainment) and in states in the South.
The paper highlighted that the greatest number of deaths could potentially be prevented in the South of the country (60%-70% deaths could be averted) than in Northern states. Lack of preventive services was one of the main factors causing the higher deaths rates among poorer individuals. The introduction of Medicare for all after the age of 65 was hypothesized to reduce inequalities significantly and research as previously found this (see here).
October 31, 2014
Brendan Walsh will be presenting a poster presentation at the 10th Annual National Cancer Research Institute (NCRI) Conference on Tuesday 4th November in the the BT Convention Centre, Liverpool.
Please come see his poster at B10.
For more information on the conference please visit the conference website at http://conference.ncri.org.uk/
October 02, 2014
Brendan Walsh will be giving a guest lecture at the Health Economics Research Centre (HERC), University of Oxford, tomorrow (October 3rd) at 1pm.
The title of the presentation is: Measuring Socioeconomic Inequalities in Cancer Screening: A Comparison across the United Kingdom, Ireland and the United States
An extended abstract can be found on our Events page.
September 18, 2014
A new video from The MacLean Center at the School of Medicine, University of Chicago by Professor Rena Conti, University of Chicago on bending the cost curve in cancer treatment in the United States. While the video is dominated by the US health care system and the impact the Affordable Care Act will have on cancer treatment costs, it is an excellent example of the importance of economics in cancer research.
Bending the Cost Curve in Cancer Treatment: The ACA and beyond
September 10, 2014,
A new study by Economics of Cancer Research Group members Richéal Burns and Ciaran O'Neill was today published in PLOSOne. This study is entitled "Factors Driving Inequality in Prostate Cancer Survival: A Population Based Study" and analyses the main determinants of prostate cancer in Ireland. Much of Richéal's work deals with prostate cancer and prostate cancer screening and previous papers from her on the subject. can be found here, here and here.
A copy of this study may be found at this link or in the document box below. Richéal has also contributed an in-depth blog on prostate cancer screening for this website.
September 10, 2014,
HPV Vaccines are Working!
Public health practitioners are now genuinely optimistic that HPV vaccination will prevent future HPV-associated cancers. While it may take years to determine the true effectiveness of HPV vaccines in reducing cancer deaths, it has been shown that an important outcome, genital warts (which occur from the Human Papillomavirus) is an important short term outcome for the HPV vaccine.
This week an article in PLOSOne from researchers in Australia again showed that women with HPV vaccination had a huge decrease (61%) in genital warts.
Vox.com in their analysis of his piece show the striking changes in the prevalence of genital warts in the graph below.
This latest research, based on nationally representative general practice data, provides further evidence of the effectiveness of the HPV vaccination and follows-on from an article published last year in the BMJ, which was based on 8 sexual health centres in Australia.
Low-risk HPV subtypes such as HPV-6 & HPV-11 cause the majority of genital warts whereas high-risk HPV subtypes HPV-16 & HPV-18 cause cancer. Unfortunately, it will be another 10 or 15 years before we see evidence on whether vaccine reduces HPV-associated cancer in this cohort of females. For sure, these are excellent signs of effectiveness. The question now for policymakers is whether gender neutral HPV vaccination is cost-effective. This subject was broached at last year’s ECRG symposium in NUI Galway. (See video below)