This is a guest post from Mike Birtwistle, Founding Partner at Incisive Health, who have just produced a new report for Cancer Research UK on the economic impact of early diagnosis.
There is now a consensus that diagnosing patients earlier saves lives. There is also recognition that late diagnosis – when a person’s cancer has already spread to other parts of the body – is one of the explanations for the UK’s poorer cancer survival, when compared to countries such as Sweden.
Yet the NHS has proved to be curiously reticent to make diagnosing cancers earlier a priority. Why?
The suspicion is that cost is a major factor. At a time when the NHS has been struggling to stay out of the red and services have been having a hard time coping with demand, the prospect of more patients needing earlier treatment has seemed daunting.
This may not seem in the interests of the public, but it may be the reality of cancer services today. A report commissioned by Cancer Research UK found recently that people working in cancer feel services are teetering on the brink.
The truth, however, is no-one has ever properly analysed the financial consequences of earlier diagnosis in planning cancer services.
So Cancer Research UK commissioned Incisive Health to do just that. Our findings, published today, show that there is a clear financial dividend from earlier diagnosis, as well as a compelling case for improving cancer survival.
Earlier stage treatment costs less
Our research looked at bowel, ovarian and lung cancers (and further divided bowel cancers into cancers of the colon and rectum). We modelled the costs of treating each cancer and assessed how these costs varied when cancers were diagnosed at different stages – either early (stage 1 or 2) or late (stage 3 or 4).
The results were clear. As well as delivering better results for patients, earlier stage treatment costs considerably less, as this graphics shows:
Overall, treatment for stage 3 and 4 colon, rectal, lung and ovarian cancer costs the NHS nearly two and a half times the amount spent on stage 1 and 2 services.
Across England there are significant variations in the proportion of patients who are diagnosed with cancer at an early stage.
For colorectal cancer, there is a nearly a threefold variation between the highest and lowest performing areas. For lung cancer the variation is nearly fourfold. And for ovarian cancer it is nearly fivefold.
This creates a significant opportunity for the NHS. If every area could do as well as the best in terms of early diagnosis, then the financial and health benefits would be significant:
- For colon cancer, savings of over £24 million could be realised (benefitting over 4,500 patients)
- For rectal cancer, savings of nearly £10 million could be realised (benefitting over 1,700 patients)
- For ovarian cancer, savings of over £16 million could be realised (benefiting over 1,400 patients)
For lung cancer, the story is slightly different. Over 3,400 patients would benefit from earlier diagnosis but, due to higher levels of recurrence in lung cancer, there would be a modest cost of £6.4 million:
But when you look at this lung cancer cost in terms of cost per year of life gained (something frequently used when talking about cancer drugs) it works out as £1,515 per year.
In health terms this is a bargain.
If these findings (which cover cancers where treatment costs are both higher AND lower for earlier stage diagnosis) were applied to all cancers, then savings in treatment costs of just under £210 million would be realised, resulting in more than 52,000 people being diagnosed with earlier stage cancer.
This shows that health services should be able to plan early diagnosis programmes in the expectation that they will be able to unlock significant savings in treatment. And they should do so in the expectation that they can achieve significant health gains for cancer patients.
We estimate that, if everywhere could do as well as the best in England, then more than 5,000 extra people each year would be alive five years after their cancer diagnosis.
The affordability opportunity
But this report is not an argument for ignoring efforts to improve treatment to instead focus on early diagnosis.
In fact it is the opposite, setting out a way in which improvements to treatment can be afforded. Earlier diagnosis will save lives and avert treatment costs. These averted costs should instead be used to fund early diagnosis programmes and better treatments for those who need them.
As the population ages, the challenge of cancer will grow. Groundbreaking research is creating opportunities to rise to this challenge.
Earlier diagnosis offers the prospect of a step change in survival and the financial headroom to make available the fruits of research.
Now we must get on and deliver it.
- Mike Birtwistle is founding partner at Incisive Health
Image via Wikimedia Commons