Economic issues in lung cancer: A review

purpose: Lung cancer is a major source of morbidity, mortality, and health care costs in the developed and developing world. it is estimated that lung cancer is responsible for 20% of all cancer care costs. Concerns exist tha t this expenditure is associated with questionable benefits. Design: The economic literature that relates to smoking was reviewed, follo wed by a summary of the economics of the diagnosis, treatment, and palliati on of lung cancer. Methodologic considerations are also discussed in this s ection. Results: Published studies suggest that the increased lifetime health care costs from smoking-related illnesses in smokers are partially or fully offs et by the higher medical costs that result from increased longevity in nons mokers. However, lost productivity costs, which result from morbidity and e arly mortality among smokers, result in an overall net cost of smoking to s ociety. Discounting rates of 3% to 5% do not substantively alter these resu lts. The per-patient cost to treat lung cancer is substantial. The major co st center is hospitalization; palliative or terminal treatment is associate d with significant costs. Savings can be obtained through the judicious use of diagnostic and staging procedures. Furthermore, combined modality treat ment approaches and the palliative use of combination chemotherapy appear t o be associated with acceptable cost effectiveness compared with commonly u sed therapies for other diseases. Conclusion: Although the increased medical care costs of treating smoking r elated diseases are somewhat offset by the higher medical care costs due to increased longevity in nonsmokers, the lost productivity that results from smoking results in a net cost to society. Standard approaches to the manag ement of lung cancer are associated with cost-effectiveness similar to that of other commonly used medical interventions. (C) 1998 by American Society of Clinical Oncology.