Health Economic Aspects of Cancer Care: Evaluating Evidence for Drug Reimbursement and Screening Programs

Abstract

To improve population health and ensure value for money, decision-making in health care must rely on transparent and well-informed evaluations of the expected costs and effects of new health interventions. The purpose of this thesis was to generate and evaluate evidence on the clinical effectiveness and cost-effectiveness of interventions introduced within the cancer care pathway to inform future policy discussions and decision-making. The thesis focuses on two areas: reimbursement decisions for cancer drugs and colorectal cancer (CRC) screening in Sweden, using descriptive analysis, econometrics, and health economic modeling. Papers I–II assessed the evidence on clinical effectiveness and cost-effectiveness underlying reimbursement decisions for new prescription cancer drugs, using public decision dossiers and published literature. The findings show that a considerable proportion of reimbursement decisions rely on inconclusive evidence regarding improvements in overall survival (OS) and quality of life (QoL). Paper III–IV evaluated the effectiveness, cost-effectiveness, and inequality impact of organized CRC screening programs in reducing incidence and improving quality-adjusted life years, using secondary literature and registry data. The results indicate that CRC screening effectively improves health outcomes and is cost-effective; however, the benefits are unevenly distributed across socioeconomic groups. In conclusion, the thesis findings imply uncertainty regarding cancer drugs’ value for money and the benefits ultimately realized by patients and society. Furthermore, organized CRC screening reduces disease burden and improves population health; yet it may exacerbate existing socioeconomic inequalities in health.