Comparison of Cancer-Related Spending and Mortality Rates in the US vs 21 High-Income Countries

IMPORTANCE: Studies using data from before 2011 concluded that the cost of US cancer care is justified given improved outcomes compared with European countries. However, it is unclear whether contemporary US cancer care provides better value than that of other high-income countries. OBJECTIVE: To assess whether cancer mortality rates in 2020 were lower in countries with higher cancer-related spending, and to estimate across countries the incremental cost per averted cancer death. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional, national-level analysis of 22 high-income countries, assessing the association between cancer care expenditures and age-standardized population-level cancer mortality rates in 2020, with and without adjustment for smoking. In addition, US incremental costs per averted death compared with the other countries were calculated. This study was conducted from September 1, 2021, to March 31, 2022. MAIN OUTCOMES AND MEASURES: Age-standardized population-level cancer mortality rates. RESULTS: In this cross-sectional study of 22 countries, the median cancer mortality rate was 91.4 per 100 000 population (IQR, 84.2-101.6). The US cancer mortality rate was higher than that of 6 other countries (86.3 per 100 000). Median per capita spending in USD for cancer care was $296 (IQR, $222-$348), with the US spending more than any other country ($584). After adjusting for smoking, 9 countries had lower cancer care expenditures and lower mortality rates than the US. Of the remaining 12 countries, the US additionally spent more than $5 million per averted death relative to 4 countries, and between $1 and $5 million per averted death relative to 8 countries. Cancer care expenditures were not associated with cancer mortality rates, with or without adjustment for smoking (Pearson R = −0.05 [95% CI, −0.46 to 0.38]; P = .81; and R = −0.05 [95% CI, −0.46 to 0.38]; P = .82). CONCLUSIONS AND RELEVANCE: In this cross-sectional study of national cancer care expenditures and cancer mortality rates across 22 countries, although the cancer mortality rate in the US was lower than the median, the US spent twice as much on cancer care as the median country. Findings of this study suggest that the US expenditure on cancer care may not be commensurate with improved cancer outcomes.