Cancers are a leading cause of mortality worldwide, with the largest absolute death toll in China, followed by India and the USA. The health burden of cancers is distributed unevenly across countries; high-income countries face a greater per-population burden than low- and middle-income countries. Additionally, the economic cost of cancer negatively affects countries’ economic growth. Beyond the costs of care, cancers result in reduced productivity, unemployment, labor losses, and reductions in capital investment. Dr Simiao Chen and colleagues conducted a decision analytical modeling study to estimate and project the economic cost of 29 cancers in 204 countries and territories. The model was the first to account for productivity losses due to cancer-related mortality and morbidity among people with different educational and experience levels, and for changes in savings and investment patterns due to treatment costs.
The study showed that the macroeconomic cost of cancers was substantial and distributed heterogeneously across cancer types, countries, and world regions, suggesting that global efforts to curb the ongoing burden of cancer are warranted. According to the analysis, the global macroeconomic cost of cancers was estimated to be $25.2 trillion from 2020 to 2050. This equates to an annual tax of 0.55% on global output, or a per capita burden of $2,857 international dollars (INT$) during the same time frame.
Across cancer types, tracheal, bronchus, and lung (TBL) cancer had the highest cost at INT $3.9 trillion, followed by colorectal cancer, breast cancer, liver cancer, and leukemia. These cancers account for half of the global economic cost of cancer. Common cancers such as TBL, breast, colorectal, and pancreatic cancer become more prevalent than cervical, liver, and stomach cancers or leukemia as income increases. High-income countries face the greatest economic burden, at 0.72% of total gross domestic product (GDP), compared with 0.26% of GDP for low-income countries. This equates to a total economic loss of INT $12.8 trillion and per capita loss of INT $10,294 in high-income countries, compared with a total loss of INT $168 billion and INT $174 per person in low-income countries. Of all the countries included, China has the largest economic cost of cancers (INT $6.1 trillion), followed by the US (INT $5.3 trillion) and India (INT $1.4 trillion). As a percentage of GDP, North America has the highest economic burden (equivalent to an annual tax of 0.83%), followed by Europe and the Central Asia (0.63%) and East Asia and Pacific (0.59%) regions. Combined, these regions account for 85.5% of the total cost of cancers worldwide. Per capita economic cost ranges from INT $241 in Sub-Saharan Africa to INT $14,065 in North America.
While high-income countries bear the greatest cost, low- and middle-income countries, which account for 86% of the study population and half of cancer’s projected economic cost, face the greater human toll. Improvements in public health policies and health system infrastructure are the key to addressing this. As an example, tobacco use is the leading preventable cause of cancer globally. As China is the leading tobacco producer and consumer, the authors suggest that increasing taxes on cigarettes and tobacco-control policies in China has the potential to save INT $1 trillion by 2030.
In a linked editorial, Dr Gilberto Lopes of the Sylvester Comprehensive Cancer Center at the University of Miami, Florida, USA, commended Dr Chen and colleagues for their innovative approach to measuring the cost of cancer on a global scale. He suggested actions to improve cancer control worldwide, such as establishment and development of a universal health coverage infrastructure with well-trained human capital, creation and implementation of national cancer control plans (eg, improved cancer registries and data repositories on cancer risk factors and treatment outcomes), tobacco control, vaccinations against common cancer-causing viruses (eg, human papillomavirus, hepatitis B virus), and promotion of healthy lifestyle choices. Dr Lopes also suggested that creation of reference cancer centers, access to essential treatments, and palliative care—especially pain control—are needed.
High level
Investment in effective public health interventions to reduce the burden of cancers is critical. The understanding of the economic cost of cancers gained in this study enables policy makers to enact appropriate strategies to curb cancer-related morbidity and mortality, allocate resources appropriately, and to build healthcare systems that can cope effectively with anticipated increases in cancer prevalence. Global efforts to contain projected increases in the burden of cancers are essential for protecting global health and economic well-being. The authors suggested that investment in cancer mitigation (eg, research and development, cost-effectiveness analyses of interventions, and cancer prevention strategies) may yield substantial economic benefits, particularly in TBL cancers. Additionally, inclusion of cost-effective cancer screening programs in insurance benefit packages may help strengthen primary-care delivery.
Ground level
The economic and social costs of cancer can also be addressed at the provider level. Innovative forms of healthcare delivery, such as community-based screening and digital health, can help to improve public health and reduce the burden of cancers through earlier identification and appropriate treatment. Additionally, rapid and appropriate introduction of new, more effective treatment options into community practice may also contribute to cost-savings while improving outcomes.