Early cancer diagnoses will cost the NHS considerably less

Early diagnosis of people with cancer saves lives. Late diagnosis – when a person’s cancer has already spread to other parts of the body – is one of the explanations for the UK’s poorer cancer survival, when compared with countries such as Sweden.

‘Cancer services feel under siege and there is a perception that earlier diagnosis could hinder rather than help’

Yet the fear that cancer services would buckle under the strain of earlier diagnosis has impeded action.

With performance on cancer waiting times dipping and showing no sign of recovery, NHS England has taken to pointing to earlier diagnosis as a cause of longer waits.

Whether or not this explanation is correct is immaterial; cancer services feel under siege and there is a perception that earlier diagnosis could hinder rather than help.

However, an analysis undertaken by Incisive Health for Cancer Research UK suggests that the opposite is the case: there is a clear financial dividend to earlier diagnosis, as well as a premium in terms of better survival.

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Calculating the costs

Our research looked at bowel, ovarian and lung cancers (and further divided bowel cancers into cancers of the colon and rectum).

We modelled the costs of treating each cancer and assessed how these varied when cancers were diagnosed at different stages, either early (stage 1 or 2) or late (stage 3 or 4).

The results were clear. As well as delivering better results for patients, earlier stage treatment costs considerably less.

Overall, treatment for stage 3 and 4 colon, rectal, lung and ovarian cancer costs the NHS nearly two and a half times the amount spent on stage 1 and 2 services.

The encouraging news is that we can shift the stage of diagnosis, and some areas of the country are already doing exactly this.

‘As well as delivering better results for patients, earlier stage treatment costs considerably less’

There are significant variations in the proportion of patients who are diagnosed with cancer at an early stage.

For colorectal cancer, there is nearly a threefold variation between the highest and lowest performing areas. For lung cancer the variation is nearly fourfold. And for ovarian cancer it is nearly fivefold.

This creates a significant opportunity for the NHS. If every area could do as well as the best in terms of early diagnosis, then the financial and health benefits would be significant for:

• colon cancer, savings of over £24m could be realised – benefiting over 4,500 patients;
• rectal cancer, savings of nearly £10m – benefiting over 1,700 patients; and
• ovarian cancer, savings could amount to over £16m – benefiting over 1,400 patients.

For lung cancer, the story is slightly different. Over 3,400 patients would benefit from earlier diagnosis but, due to higher levels of recurrence, there would be a modest cost of £6.4m. When you look at this cost, however, in terms of cost per year of life gained, it works out as £1,515 per year: in health terms this is a bargain.

What to expect

If these findings were applied to all, savings in treatment costs of just under £210m would be realised, resulting in more than 52,000 people being diagnosed with earlier stage cancer.

‘If everywhere could do as well as the best in England, 5,000 extra people each year would be alive five years after diagnosis’

This shows that health services should be able to plan early diagnosis programmes in the expectation that they will be able to unlock significant savings in treatment.

And they should do so fully expecting to achieve significant health gains for patients with cancer.

We estimate that, if everywhere could do as well as the best in England, more than 5,000 extra people each year would be alive five years after their cancer diagnosis.

Is it affordable?

There has, of course, been a good deal of debate in recent weeks about access to expensive radiotherapy and cancer drug treatments.

As I have argued, further action is required on these issues.

‘As the population ages, the challenge of cancer will grow’

Our analysis is not an argument for ignoring efforts to improve treatment to focus instead on early diagnosis. Rather, it sets out the way in which the sustainability of cancer services can be assured.

Invest in early diagnosis, avert treatment costs and use the savings to make available the best treatment to those who need it.

As the population ages, the challenge of cancer will grow. Groundbreaking research is creating opportunities to rise to this challenge.

Earlier diagnosis offers the prospect of a step-change in survival and the financial headroom to make available the fruits of research. Now we must get on and deliver it.

Mike Birtwistle is a founding partner of Incisive Health