Balancing costs and benefits in cancer therapy and prevention.

In an era of increasing cost containment in health care, it has become extremely important to allocate resources as efficiently as possible. This implies that formal health economic considerations are taken into account. One field of increasing importance is that of economic appraisal, which allows quantifying the value for money of medical interventions. This type of research is extremely useful in the field of supportive care for cancer patients. In addition to economic considerations, social, political and ethical issues will also have to be addressed. Finally, the sum of these activities will enable us to make better choices in health care and ensure that sufficient resources are allocated to supportive cancer treatment. From a clinical economist’s point of view, cancer care represents a great challenge. Many issues have evolved over recent years, often yielding more questions than answers. The complexity of the matter, the interdisciplinarity of the approach and the emergence of an increasingly cost conscious health care environment put cancer care in a difficult realm. Cancer patients have physical, social, spiritual and emotional needs. They may suffer from severe physical symptoms, from social isolation, spiritual abandonment and emotions such as sadness and anxiety, or feelings of deception, helplessness, anger and guilt. In some patients, the disease is rapidly progressing and ultimately they die. Their demanding care evokes intense feelings in health care providers, the more since these incurable patients represent a challenge, which could be condensed under the heading ‘the challenge of medical omnipotence’. The economic burden of cancer is tremendous. It is estimated that approximately 10 million people worldwide suffer from neoplasms. Radice and Redaelli estimate that this figure will increase to 15 million people by the year 2020 [1]. The associated economic burden may well lie in the range of €250–350 billion.