Paying for a Long-Fighting War
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Paying for a Long-Fighting War The Healthcare Dilemma of Cancer Medicines Xiaotian Zhong Pfizer Global Research & Development, Cambridge, Massachusetts, USA
Abstract
The ‘war on cancer’ declared by President Nixon nearly 4 decades ago has fostered intensive research revealing the biological details and complexity of cancer. However, despite the global efforts in research, prevention and disease awareness, cancer incidence worldwide has continued to rise. Global demand for the commercial development of cancer medicines is growing, contributing partly to the rapid increase in health spending. One great challenge facing society is how to fund the implementation of cancer care in an increasingly expensive world under the current challenging economic circumstances. There is a growing dilemma regarding how much society is willing to pay for innovative drugs. This review finds that the reasons behind these developments can be attributed to several factors, including limited supply and rising demand for innovative drugs, significant cost increase in drug development and pricing expansion with growing fixed cost. Society must address these challenges by fairly defining and rewarding an appropriate value for innovative medicines, by determining their suitable portion in health expenditure and balancing healthcare resource prioritization.
Hippocrates (figure 1) coined the term carcinoma from the Greek words carcinos (crab or crayfish) and oma (swelling) around 400 BC. Today, the term ‘cancer’ describes a collection of diseases characterized by proliferation of malfunctioning
Fig. 1. Mural painting showing Hippocrates (referred to as the ‘father of medicine’ who first coined the word ‘carcinoma’) and his student Galen (12th century, Anagni, Italy; credit to Nina Aldin Thune).
cells in different anatomical locations. Cancer is not a single disease but a wide range of afflictions classified into over 200 different types.[1,2] Cancer is a major public health burden. On 23 December 1971, President Nixon signed the National Cancer Act, converted a biological warfare facility into a cancer research centre and declared war on cancer. Yet, despite the tremendous efforts and attention that have been directed toward reducing the cancer burden through prevention, screening and disease management, cancer incidence worldwide has continued to rise. In 1995, the WHO[3] estimated that there were 3.5 million cancer deaths and 5.3 million new cases of cancer annually. In 2000, there were approximately 10 million new cases. By 2030, the WHO assessed that the global incidence will be up by 50% to 15.5 million cases.[1,2] In 2007, 7.9 million people died of cancer; 13% of 60 million total deaths worldwide. Cancer recently surpassed cardiovascular disease to become the leading cause of death in developed nations. Deaths from cancer worldwide are projected to continue rising, with an estimated 12 million deaths in 2030. The causes behind the global increase in cancer incide
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