A research announcement from Nordic Cancer Union (NCU)

Background
Nordic Cancer Union (NCU), a confederation of the Nordic cancer societies, invites researchers or group of researches at your institution to tender for funds and conduct a research project examining three focal problems:

1) The costs of cancer in the Nordic countries
2) A prediction of costs in the Nordic countries
3) Possible economic benefits of improving cancer care in the Nordic countries

During the last 50 years or so the incidences of cancer in the Nordic region, as in other parts of the world, has increased significantly. Statistics from the national cancer registers shows that more than 120 000 people living in the Nordic countries got a cancer diagnosis in 2003. This is nearly twice as many as in 1970. Comparable national registrations that year shows that around 700 000 people in the region were alive after having had a prior cancer diagnosis.

Cancer affects people at all ages but its frequency increases rapidly with age. The Association of the Nordic Cancer Registries (ANCR) has made predictions (2002) which point towards a substantial increase of cancer incidences in the near future. This increase is mainly due to changes in the size and age structure in the population of the Nordic countries. From the period 1993-1997 up to the period 2018-2022 the average annual numbers of new cases in the Nordic countries are expected to increase with 49 % in males to almost 76 000 new cases, and by 34 % in females to more than 69 000 new cases. (Møller et.al. 2002, Prediction of cancer incidence in the Nordic countries up to the year 2020).

The Nordic countries are likely to face forthcoming economic challenges because of social aging and more cases of cancer among its populations. Altogether, the Nordic countries will have to distribute more resources from the national health budgets in order to cope with increasing cancer incidences. In addition, the fact that more and more people survive cancer will most likely demand improvements of, and thereby financial contributions, to follow-up treatment and rehabilitation of large groups of patients. Costs related to developing new medicine and treatment equipment is another expense that is likely to increase as well.
The purpose
A major rationale behind our decision to instigate a forward-looking economic analysis regarding cancer is to obtain information and grounds for forthcoming decision-making processes about health and cancer. Improved knowledge of the correlation between demographic structures, cancer and the economic burden of more cancer incidences in society are, we believe important for strategic reasons. New-fangled facts about costs, now and in the future, as well as possible economic gains due to improving the entire pathway of cancer care can bring about synergy effects that can be used to influence decision makers. The results of the study will, we believe, have a bearing on the way national health administrators, politicians, scholars and cancer organizations in the Nordic region manage their work concerning cancer control. For instance, if we get to know the economic burden of cancer in society we will attain a basis for evaluating economic implications of possible reductions of cancer incidences. A health economic study can also be used as a source for examining priority setting issues concerning national health budgets. Moreover, figures about expenses can be transferred and added to further specific cost-effective analysis, for instance in regard to potential implementation of new cancer medicine, improved processes in the patient pathway and improved treatment methods.
What we aim for
As pointed out in the beginning we would like to encourage researcher at health economic institutions to work out a research project that intend to answer three focal problems. Here follows a description of what we aim for.

Cost analysis
Initially we would like to obtain cost estimates of the total societal expenditures related to cancer in the Nordic countries. Our goal is to obtain a description of the direct and indirect costs, at present and in the future, of cancer in Sweden, Denmark, Finland, Norway, Island and Faroe Islands.

It is important for NCU to obtain cost estimates that can be used politically and strategically in all countries individually. We acknowledge that structural differences between the health and social systems in the Nordic countries may cause methodological challenges in regard to the possibilities for national comparison. In order to ensure the accuracy of costs related to different cancer care within the Nordic countries, given the heterogeneous nature of the organization, NCU requires that the analysis is dynamic and completed in a way that pertains to the particular cancer care situation in each country. A second requirement is that NCU members should be given the opportunity (if considered necessary) to present views regarding ways of collecting economic data.

A rough account of what we want to acquire is presented below. This list is not meant to be an exhaustive scheme, and applicants are free to include other groups of costs that may add strength to the analysis. By direct costs we have in mind costs that pertain to activities in hospitals and the primary health care sector and other costs associated with:

• prevention
• diagnostics
• treatment
• medication
• palliative treatment
• rehabilitation
• sickness benefits
• disability benefits
• transportation
• social security benefits
• sickness allowance for relatives

By indirect costs we purport the expenses society has to disburse because of loss of production capacity:
• mortality
• sickness absenteeism
• early retirement


One possible way to make a further distinction of the direct costs is to separate between different contributors in the health sector. Initially, there can be made a distinction between the expenses related to cancer in closed care services and open care services. Closed care services-costs can be defined as expenses that can be tracked to long- and short-term care and treatment in specialist health care institutions where the patients are hospitalized in hospitals, nursing homes or other institutions where patients reside for long or short terms. Open care services-costs are here defined as expenses associated with care and treatment that regard treatment and care that do not involve hospitalization in a medical institution. Services provided by primary health care institutions relate to this category. A third classification of cost can be additional services, or activities that concern the remaining activities in the cancer treatment/care area.

This proposal is by no means meant to be a required way of defining the boundaries of cancer costs, but rather to be taken as a point of departure for further specification and suggestions by specialists in the field. Registry-based prognosis from ANCR regarding the forthcoming cancer situation in the Nordic countries should be applied to the cost analysis in the proposed research project.

Prediction of costs
Given the projections of more cancer in society purported by ANCR and the initial cost analysis: What scenario in regard to costs is possible to present by way of projecting cost analysis in 10, 20 or 30 years? For instance, how much more money would have to be allocated to health budgets to obtain the same level of cancer care as today in each country?

Cost effectiveness
A third matter that we would like you to explore is the value of intervention or possible economic benefits due to improved cancer care. It is reasonable to believe that ameliorating processes along the whole patient pathway – from prevention to palliative treatment, shortening of waiting time for cancer treatment, introduction of new medicine and the latest technological facilities will cause better prognosis, less sick leave and prolonged life expectancy among cancer patients. A hypothesis based on these premises could be that improvements in cancer care in general will (despite being costly) lead to lesser indirect costs and thereby reverse the loss of production capacity in society because of cancer. NCU would like you to suggest methods on how to estimate some positive economic effects due to more extensive overall treatment of cancer patients.


Who can apply?
The competition is open for researchers with competency in health economics.
Application requirements
The application/project proposal must include:
• Formal information including position, address, telephone, telefax, e-mail of principal investigator
• Name, position and address of co-applicants (signed “Letter collaboration commitment” with names of co-applicants must be enclosed”. Signatures must be in original)
• Description of the project (maximum 10 pages).
• Work plan and time schedule
• Specified budget
• Short Curricullum Vitae including a list of publications from the one responsible for the project (maximum 1-2 A4 pages)
• The application must be written in English

The application should be sent in 1 original + 3 copies to:
Nordic Cancer Union, Kreftforeningen, Postboks 4750 Vika, 8608 Mo i Rana.
Deadline
The application must be post stamped by 1st of June 2008.
Awarding criteria and professional assessment
The applications will be evaluated by a scientific committee compounded by health economics from international research institutions. The project proposals will be evaluated by the following criteria:
• Scientific quality and relevance and methodological approach according to proposed problem(s)
• Feasibility of the suggested project
• A detailed cost estimate/budget
Contact persons
The NCU secretariat, The Norwegian Cancer Society

John Stigum
Phone: +47 41644510
E-mail: john.stigum@kreftforeningen.no

Ole Alexander Opdalshei
Phone: +47 90 19 45 59
E-mail: oao@kreftforeningen.no
Links to summaries of cancer cost studies completed in Sweden and Finland

http://www.cancerfonden.se/upload/Dokument/Cancerfondsrapporten%202006/Sammanfattning_Cancerfondsrapporten_2006.pdf