The direct costs of cancer care: a review of recent trends and variations in 39 countries

Abstract Background The global rise in cancer incidence and survivorship is contributing to escalating health-care expenditure. Yet comprehensive and internationally comparable data on direct cancer costs worldwide remain scarce, limiting insights into cross-country spending patterns, their relationship to cancer outcomes, and future cost trajectories. Methods We assembled data on direct cancer costs up to the year 2022 from academic journals, government statistical reports, and the grey literature. Drawing from 19 sources in 39 countries, we estimated total, per-patient, and per-capita cancer expenditure in US dollars (US) by cancer type, assessing associations between spending and cancer outcomes, alongside recent trends. Results Annual cancer costs varied substantially and reflected differences in national income, ranging from US1989 per diagnosis (Ethiopia) to US129 494 per diagnosis (United States). Annual costs per capita ranged from US1. 43 (Ethiopia) to US713 (United States). Annual expenditure was positively correlated with survival for most cancers but showed diminishing returns in high-income countries. Moreover, expenditure had no apparent relation with overall cancer mortality. Where data were available, spending patterns by cancer type reflected country-specific incidence profiles. Across all countries, the 4 costliest cancers accounted for one-third to almost one-half (37%-48%) of direct cancer costs. In countries with reliable time series, costs rose steadily over time, with growth rates ranging from 1. 4% (Japan, 2009-2022) to 9. 3% (Republic of Korea, 2004-2022). These increases consistently outpaced gross domestic product growth by 1. 0%-7. 7% over the respective observation periods. Conclusion Greater reforms to cancer control, and health-care more broadly, are required to ensure long-term fiscal sustainability while maximizing population health outcomes.