Economic evaluation of cancer treatments

Cancer is an important cause of illness and death, accounting for a high percentage of mortality in Western countries. In the Netherlands, about 30% of all deaths is due to cancel' and the prevalence, an indicator of the present burden of illness to society, is clearly rising (Coebergh, 1991). In the last decades cancer treatment has shown a rapid evolution. It is now a multidisciplinary treatment strategy incorporating surgery, radiotherapy, chemotherapy and immunotherapy. The high incidence and prevalence of cancer make this disease a major economic issue. The direct medical costs are considerable and are still rising due to the increased use of expensive drugs, radiotherapy equipment, the growing attention to various kinds of palliative interventions and survival success. In the Netherlands, the total direct medical costs of malignant cancer amounted to 1052 million dollars in 1988, that is 4.8% of total health care costs. About 60% of this expenditure was produced by inpatient hospital care, about 30% by outpatient hospital care and about 10% by non-hospital care (Koopmanschap et al., 1994). It is expected that in 2020, as a result of ageing, these costs will have increased much more rapidly than total health care costs. Finally, the high prevalence of morbidity, mortality and the consequent loss in production also cause high indirect costs.

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