Reassessing the Alignment of Cancer Spending With Global Burden
Kayleigh Bhangdia, Hans Elliott, Angela Apeagyei, Lisa M. ForcePURPOSE
Global cancer burden is shifting toward low- and middle-income countries (LMICs). However, advances in cancer control born from funding in high-income countries (HICs) have not been equitably distributed, contributing to worse cancer outcomes in LMICs. A previous study from 2010 estimated that 5% of global health spending on cancer occurred in LMICs despite bearing nearly 80% of the cancer burden, but updated analyses are required to guide financing strategies amid tightening global health budgets. This study estimated relative cancer spending in LMICs versus HICs in the contemporary era and evaluated the alignment of spending with global cancer burden.
METHODS
We estimated global cancer spending using the WHO Global Health Expenditure Database, the 2023 Global Burden of Disease Study, the Financing Global Health 2025 database, and published literature. We extracted non-communicable disease (NCD) spending for 59 LMICs (2013-2022) and cancer-specific spending for three HICs (2012, 2017, 2019). To estimate cancer-specific spending in LMICs, we estimated the proportion of total NCD spending that was cancer-related based on the cancer-to-NCD disability-adjusted life years (DALYs). We then multiplied this proportion and total health spending to estimate country-specific cancer spending. Similarly, based on the ratio of cancer to total spending from literature, country specific HIC cancer spending was estimated. Aggregate totals were compared against burden measures, including incident cases, deaths, and DALYs.
RESULTS
We estimated that 17.2% of total global cancer spending was in LMICs while 76.6% of global cancer DALYs were in LMICs in 2018. Significant disparities were observed in spending per DALY and per incident case between income groups. While HICs have seen decreasing age-standardized cancer mortality rates from 1990 to 2018, many LMICs continue to face rising age-standardized incidence and mortality rates with disproportionately low resources.
CONCLUSION
Despite international initiatives, misalignment between cancer burden and spending in LMICs remains profound, contributing to lower survival and potentially avoidable deaths. These findings call on policymakers, researchers, and advocates to prioritize sustainable, equitable cancer financing aligning investment with burden. Future research should establish a continuously updatable framework for tracking cancer financing flows, including spending type and recipient, enabling targeted resource allocation within constrained global health budgets.