ArticlesEconomic burden of cancer across the European Union: a population-based cost analysis
Introduction
Cancer is a major public health issue. In 2008 alone, 2·45 million people were diagnosed with cancer in the 27 countries of the European Union (EU). Cancer incidence and mortality has been reduced in developed countries due to several factors including advances in early detection, diagnostic approaches, and cancer treatment, and lifestyle changes and the development of prevention vaccines for some cancers.1, 2 Nonetheless, more than 1·23 million people still died because of cancer in the EU in 2008. About half of all new cancer diagnoses and deaths in this region in 2008 were attributable to just breast, colorectal, lung, and prostate cancers.
Cancer imposes a substantial economic burden on society. Substantial health-care costs are associated with its prevention and management.3 Moreover, some patients are unable to continue working, and many rely on friends and family for support during treatment or in the last phases of the disease. Therefore, quantification of the economic burden of cancer in the EU needs not only an estimation of the costs of cancer to health-care systems, but also an estimation of the lost earnings associated with the inability to work (due to illness or premature death) and the costs of unpaid care provided by patients' friends and relatives.
The costs of cancer have been assessed in individual countries—eg, Germany,4 the Netherlands,5 and England6—and across different European countries.7 However, the whole economic burden of cancer—including direct health care, informal costs, and economic losses to countries because of premature mortality and morbidity—has not been analysed across the EU in a comparative study. The delivery of affordable cancer care systems requires public health and policy intelligence to incorporate a comprehensive estimation of the costs of cancer care.8 A systematic cost-of-illness study can provide valuable data for the relative socioeconomic burden of different diseases, which can inform an objective public policy framework for the allocation of governmental research funds.9, 10 We aimed to estimate the economic burden of cancer across the 27 countries that made up the EU in 2009, as well as the specific proportions of total cost attributable to breast, colorectal, lung, and prostate cancers.
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Analysis framework and data sources
We evaluated the costs of all cancers in a population-based cost analysis. Cancer is defined here by the WHO International Classification of Diseases, 10th revision, codes C00–97. We estimated costs associated with breast (C50), colorectal (C18–21), lung (C33–34), and prostate (C61) cancers separately.
We used one methodological framework to obtain data for, and value cancer-related resource use in, each of the 27 EU countries. We used the same framework as applied previously to estimate the
Results
We estimated the total economic cost of cancer in the EU as more than €126 billion in 2009 (table 1). The four countries with the highest populations in the EU—Germany, France, Italy, and the UK—accounted for €82·9 billion (66% of all costs). The lowest overall costs were recorded for Bulgaria, Cyprus, Estonia, Latvia, Lithuania, Luxembourg, and Malta; the combined costs in these countries accounted for only €1·23 billion (1%). Results of the sensitivity analyses showed that a 20% variation in
Discussion
We estimated the total cost of cancer in the EU at €126 billion in 2009, of which €51·0 billion (or €102 per citizen) were incurred by EU health-care systems. However, 60% of the economic burden of cancer was incurred in non-health-care areas, with almost €43 billion in lost productivity attributable to early death. Although the economic cost by cancer type varied between EU countries, lung cancer had the greatest overall economic burden of the four cancers we studied. To our knowledge, ours is
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