The cost of cancer drugs is driven by the US market. Currently 75% of the global cancer drug expenditure is in the US – yet which only 5% of global population. Predicting the future total lifetime costs of optimal care for the "big four" cancers (lung, breast, colorectal, and prostate cancer) is complex due to the interplay of several dynamic factors, including advances in treatment technologies, drug pricing and policies, demographic shifts, and changes in healthcare delivery models.

The current high proportion of global cancer drug costs attributed to the U.S. is influenced by several factors, such as drug pricing, healthcare policies, and the rate of adoption of new cancer treatments. Here are key considerations and methodologies that could be employed to project changes in these costs:

Innovation in treatment: The development of new, more effective, but potentially more expensive treatments, including targeted therapies and immunotherapies, could increase the cost of care. Conversely, these treatments might improve survival and reduce the duration or intensity of care needed, potentially offsetting some of the cost increases. Predicting how the total lifetime costs of optimal cancer care for the four major cancers (lung, breast, colorectal and prostate) will evolve globally and in the US specifically is challenging with many variables at play.

US cost trajectory: Continued premium pricing of new cancer therapies in the US, even those with marginal benefits, will sustain higher per patient costs relative to other nations in the next 5-10 years. However, eventual pricing reforms driven by unsustainable drug expenditures are likely in the 2030s timeframe. These could include mandated cost-effectiveness thresholds for coverage, increased use of international reference pricing, and legal constraints on annual price hikes. This may slow cost growth rates. Coinciding expansion of preventive screening, personalized treatment based on advanced diagnostics, and enrolment into value-based payment programs may begin to bend the cost curve as well.

Global cost trajectory: Predicting the change in total lifetime costs of optimal care for the big four cancers is challenging due to the complex interplay of several factors, including the US market influence. Changes in US pricing policies, insurance coverage, and patent regulations can significantly impact global costs.

Drug development costs: The high cost of research and development (R&D) for new cancer drugs contributes significantly to their price. Advancements in technology and streamlined approval processes could potentially reduce R&D costs.

Treatment regimens: Optimal care involves not just drugs but also surgery, radiation, and other supportive therapies. Cost variations in these areas also influence total lifetime costs.

Adoption of new technologies: Emerging technologies like personalized medicine and minimally invasive surgeries could affect costs depending on their effectiveness, accessibility, and affordability. The introduction of generic versions of chemotherapeutic agents and biosimilars for biologic drugs could reduce the cost of cancer care, although the impact may vary by cancer type and healthcare system.

Healthcare policy changes: In the U.S. and globally, changes in healthcare policies, including drug pricing reforms, insurance coverage expansions, and the adoption of value-based care models, could significantly affect the costs of cancer care. Aging populations are more likely to develop cancer, which could increase the demand for cancer care and its associated costs. However, improvements in prevention and early detection could reduce the incidence of advanced cancers, potentially lowering costs.

Shifts in care delivery: Increasing use of outpatient care, telemedicine, and at-home cancer treatments could reduce hospital stays and associated costs. The integration of palliative care and supportive services earlier in the treatment process could also impact costs. Per patient costs of optimal cancer care will rise rapidly in low-middle income countries as access to innovative drugs, advanced radiotherapy, genomic profiling and immunotherapies diffuses globally. Some costs may eventually approach current US prices. Simultaneously, rising incomes, aging populations and Westernization of lifestyles will expand cancer incidence rates in populous middle-income nations.

Taken together, this suggests the geographic concentration of global cancer costs in the US (currently 75% of total spend) will likely fall to 40-50% by 2050. The cost impact of cancer will distribute much more globally. But predicting total lifetime costs by tumour type will depend heavily on trends in early screening, personalized treatment and targeted prevention - which could ultimately prove cost-saving if broadly implemented at a global scale. Given these complexities, definitive predictions are difficult. However, some potential scenarios emerge:

• Continued cost increase: If current trends persist, the total lifetime costs of optimal care could continue rising, fuelled by expensive new drugs, limited market competition, and increasing demand for advanced therapies.
• Gradual cost stabilization: Increased competition in drug development, value-based pricing models, and wider adoption of cost-effective technologies could lead to a gradual stabilization of costs.
• Cost reduction: If fundamental changes occur, like significant R&D cost reduction, broader implementation of generic drugs, and efficient healthcare systems, total lifetime costs might even decrease.

Considering different future scenarios (e.g., rapid innovation vs. slow innovation, changes in healthcare policies, etc.) a detailed scenario analysis can provide a range of potential future costs. This approach allows for the exploration of how various factors might interact to influence overall costs.

Conclusion: While precise predictions are challenging due to the complexity and variability of factors involved, employing sophisticated modelling techniques and considering a wide range of scenarios can offer valuable insights into potential future trends in the lifetime costs of care for the big four cancers. It's clear that both technological advances and policy reforms will play critical roles in shaping these costs. Ongoing monitoring of trends and adaptability in healthcare delivery and financing models will be crucial in managing the future economic burden of cancer care.