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Skip to 0 minutes and 1 secondCan we afford to treat all the cancers that arise in our society? There are, obviously, arguments for and against this proposition. The reason people worry about it is that cancer is becoming more prevalent. Now, we have to be careful here. Many of our most important cancers are actually becoming less common in terms of age-specific incidence. So for instance, the incidence, the new cases, of lung cancer have declined substantially in many countries as the smoking epidemic has been brought under control. In our own country of Scotland, there was once a time when 80%, 80% of males smoked. Today, it's less than 20%. So the incidence of cancer has declined.

Skip to 0 minutes and 46 secondsHowever, the improved life expectancy that's happened in many countries, while we've controlled the risks of some cancers mean that many people now live in to an age group where cancer is more common. So the prevalence of cancer and the varieties of cancers have become greater. Allied to that is the awareness that some of the risk factors for cancer have become more common. So just as smoking has declined in Europe and North America, it's become more common in parts of Asia and Africa and some aspects of the diets that we eat in the industrialised world are predisposed towards cancer.

Skip to 1 minute and 30 secondsAlcohol is a risk factor for many cancers and there's no doubt that the cosmopolitan diet of the Western world and alcohol consumption has become more common in many locations. So you put all of this together, the ageing population together with the rising incidence of certain risks for cancer, and the burden of the disease becomes greater. At the same time, our ability to treat it has become much more sophisticated. The mainstays of surgical treatment and radiotherapy have now been added to by a vast array of chemotherapeutic agents, many of which are famously very expensive and the cause of some controversy.

Skip to 2 minutes and 17 secondsAlso, the inflation or the rising cost of many of these technologies outstrip the usual levels of economic growth in countries, like those in Europe and North America. So these factors combine. The expansion in medical technology, the ageing population and the rising risks together with the whole problem of inflation and cost pressures become sometimes extreme. There's also the issue of efficacy. If a new treatment is very expensive and only extends life expectancy marginally, should a wise government fund such an agent? Again, these are controversial issues. Now, the flip side of the argument is an ethical one. It is that human life is more valuable than anything else and that if we can provide a treatment, we're ethically required to do so.

Skip to 3 minutes and 20 secondsThat's a simple and straightforward argument, and it's lined up against these other cost and expansion pressures that I have set out already. Now, the tools we use to provide data to help us make decisions about these issues are, broadly speaking, what we call health economics. And what we do here is we look at the cost and the benefits of treatment. Now, benefits can be thought of in very wide terms and are sometimes difficult to establish. So we use other terms, like cost utility and the most common of these cost utility tools is the quality-adjusted life years. So what this means is that we make an assessment of the additional years of survival, but also the quality of those years.

Skip to 4 minutes and 11 secondsAnd health economists can do studies, which allow us to compare different forms of treatment and the number of quality-adjusted life years that result from them. Now, this has been done and these tables and these data are now widely available for patient groups, for clinicians, for politicians and for policymakers. And in broad terms, there's usually a threshold. If the cost for a single quality-adjusted life year rises too much, pressure comes from government not to fund that agent. Of course, that can be argued against by patient groups who would want that for themselves or for their relatives and that is the nature of the debate we find ourselves in at the moment. How far should we go?

Skip to 5 minutes and 5 secondsIs there a point at which the benefit is really not justified in terms of the cost? And there is no resolution to that. The views of politicians, of clinicians, of policymakers, of patient groups, of their relatives, and, indeed, of the whole population whose taxes fund these things need to be considered. And our societies find ourselves now in quite passionate debates about how we're going to resolve these issues. For those studying cancer, the important thing is to establish the facts as clearly as we can. What is the nature of the disease? What is its likely course? What is the philosophy of treatment we're adopting? And what are the health economic parameters that will help us to make a decision about them?

Skip to 5 minutes and 57 secondsThese are all dilemmas and they're very real and are likely to become more pressing as we go forward.

Health economics

Professor Phil Hanlon outlines some of the key concepts of Health economics in relation to cancer treatment.

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This video is from the free online course:

Cancer in the 21st Century: the Genomic Revolution

The University of Glasgow