Cancer care

Cancer care · Ageing · Access

The Growing Cost of Cancer Care

An older population will need more treatment. Personalised vaccines could improve that treatment—and make the question of who pays more urgent.

Evidence and public prices reviewed 23 October 2026

Even if cancer treatment did not become more expensive, ageing populations would make cancer care harder to finance. OECD modelling estimates that population ageing alone could raise cancer-related health expenditure per person by 67% across OECD countries and 59% across EU countries between 2023 and 2050, assuming unchanged age-specific incidence and survival and current treatment costs. Higher prices and more intensive regimens would add another source of pressure. [1]

+67%

OECD countries

Average projected increase per resident

+59%

EU countries

Average projected increase per resident

A demographic scenario, not a forecast of drug-price inflation or a prediction for every country. “Per person” means per resident of the population, not per patient with cancer. The EU and OECD groups overlap; the percentages are not additive.

This is the setting in which personalised mRNA cancer vaccines may enter routine care. A treatment that prevents recurrence can spare patients further illness and reduce later medical costs. But if it is added to an already expensive regimen, health systems must pay more today, while the size and timing of future savings remain uncertain.

More patients, even when some risks fall

The demographic pressure is already visible in Belgium. My earlier post, Why Are Cancer Diagnoses Still Rising?, examined the distinction between diagnosis counts and age-standardised rates. Its analysis of Belgian registry and population data found that annual diagnoses rose by 34.6% between 2004 and 2024, with population growth and ageing together accounting for about 89% of that increase. That is a decomposition for a particular country and period, not a universal proportion.

Age adjustment helps explain the increase; it does not remove the need for appointments, surgery, medicines or follow-up. A country can reduce cancer risk at comparable ages and still face a growing number of patients. Longer survival can also increase the number of people living after a cancer diagnosis. That is welcome progress, but it brings continuing care needs.

What the vaccine headline actually buys

Moderna and Merck’s phase 3 INTerpath-001 trial illustrates both the promise and the uncertainty. It enrolled 1,137 patients after complete surgical removal of stage IIB–IV melanoma. Adding intismeran, an individualised mRNA vaccine, to pembrolizumab (Keytruda) reduced the hazard of recurrence or death by 42%: hazard ratio 0.58, with a 95% confidence interval of 0.45–0.75. [2]

The absolute difference matters

Reported two-year recurrence-free survival was 82.2% with the combination versus 70.0% with Keytruda alone. That is a 12.2-percentage-point difference, equivalent to roughly 8–9 patients treated for one fewer recurrence-or-death event by two years. It is not a count of additional cures or lives saved.

Overall-survival results remain immature. The company release reports pooled results rather than detailed estimates for each stage; resected stage IV disease is also different from active, unresectable metastatic cancer. The announced findings are encouraging, but they do not yet establish the lifetime health gain that an economic model would need. [2]

The price of an additional treatment

As of 23 October 2026, intismeran remains investigational and no commercial price has been publicly announced. Figures such as $100,000 or $200,000 per course should therefore be labelled as assumptions. There is no reliable single price for “mRNA drugs”: the technology covers very different products.

For comparison, the CDC’s current US private-sector prices for mass-produced mRNA vaccines are about $152 per dose for Spikevax and $319 for mRESVIA. These are neither patient bills nor estimates for a personalised cancer vaccine. Individual cancer treatments require tumour analysis, antigen selection, production and quality checks for each patient. Manufacturing economies may improve, but a lower production cost does not automatically mean a lower selling price. [3]

The partner medicine already has a substantial price. Merck lists Keytruda at $25,034.88 per 400-mg dose in the United States, current to September 2026. Nine such doses—the maximum planned in the melanoma trial—calculate to about $225,314, before the vaccine, administration or other care. Discounts and early discontinuation can reduce actual expenditure. [2] [4]

National prices differ. NICE records a UK list price of £2,630 per 100-mg vial and a confidential NHS discount. The same nine-dose calculation gives £94,680 before that discount. Public list prices help show scale, but they cannot establish what a particular health service actually pays. [5]

What an add-on price could mean

Illustrative scenarios · Not announced vaccine prices

Full-course acquisition costs in US dollars. The 10,000-patient cohort is hypothetical.

Assumed vaccine course	Vaccine + Keytruda*	Added vaccine cost for 10,000 patients
$50,000	About $275,000	$500 million
$100,000	About $325,000	$1 billion
$200,000	About $425,000	$2 billion

*Uses nine 400-mg Keytruda doses at the September 2026 US list price. Excludes discounts, administration, testing, adverse-event costs and future savings. Actual treatment completion varies. These are expenditure illustrations, not reimbursement estimates.

The underlying issue is that the vaccine currently adds treatment rather than replacing Keytruda. Other programmes could add still more components: BioNTech and Genentech are testing autogene cevumeran plus atezolizumab and chemotherapy against chemotherapy alone after pancreatic-cancer surgery. That is an experimental comparison, not an established new standard. [6]

Preventing recurrence can save money—but not automatically

Recurrence can require further surgery, radiation, medicines and hospital care. Preventing it has financial value as well as obvious value to patients. Yet the vaccine must be paid for across the whole treated group, including people who would have remained recurrence-free with existing treatment.

Using the reported two-year absolute difference, a hypothetical $100,000 vaccine course corresponds to roughly $820,000 in vaccine expenditure per additional recurrence-or-death event avoided by that time. This calculation divides $100,000 by 0.122. It excludes both delivery costs and downstream savings; it is not a cost per life saved. Longer follow-up could change the result, and recurrence and death cannot be treated as interchangeable cost events.

Formal cost-effectiveness studies estimate additional costs relative to additional health gained, often in quality-adjusted life-years. Their conclusions depend on how long benefits last. An exploratory 2024 model of this vaccine combination projected overall-survival effects from recurrence and metastasis results rather than observed overall-survival data. Its favourable estimates therefore cannot settle what the treatment is worth. [7]

A treatment can be worth paying for without saving money. It can also offer reasonable value per patient while remaining difficult to fund for everyone eligible.

Belgium’s warning about outcomes in ordinary practice

A previous post reported that half of Belgian patients receiving expensive treatments such as Keytruda and Opdivo died within a year of starting treatment. The underlying AIM research examined 9,233 immunotherapy recipients in 2016–2018 and found that 8.4% began treatment less than a month before death. Those findings raise legitimate questions about treatment timing and patient selection. [8]

They do not establish that the drugs provided no benefit: mortality among treated patients alone does not reveal what would have happened without treatment. Nor can those outcomes predict the effect of vaccination after complete melanoma resection. The populations and treatment goals differ. The useful lesson is that reimbursement decisions need continuing evidence from ordinary practice, including quality of life, treatment completion and outcomes in older or medically complex patients.

The household pays in more than one way

National expenditure and patient hardship are related, but they are not the same measure. An insurer may cover most of an expensive medicine while a household still struggles with transport, accommodation, reduced earnings and unpaid caregiving. These burdens, together with direct medical payments and financial anxiety, are often called financial toxicity. [9]

Universal coverage does not eliminate the problem. A European survey published in 2025 included 2,507 patients: 56% reported income loss, 86% additional treatment-related expenses, and 16% delaying or avoiding healthcare. These are findings from a multinational survey, not representative estimates for every country or evidence specific to mRNA vaccines. Younger patients with children and self-employed patients were particularly vulnerable. [10]

In the United States, the insurance arrangement can leave patients more directly exposed. Original Medicare generally involves 20% coinsurance for Part B services after the deductible and no annual out-of-pocket ceiling without supplemental coverage. The $2,100 Part D cap for 2026 applies to Part D medicines, not every cancer-related bill. Future coverage for an unapproved personalised vaccine cannot yet be assumed. [11]

For retired patients, a pension may cushion some employment-related losses, while limited savings, travel and dependence on family still create difficulties. Extra visits have a cost even when the medicine is reimbursed. Conversely, avoiding recurrence can spare a family another prolonged period of illness and lost income. Both sides belong in an assessment of value.

Making progress affordable

For health services, ageing increases demand while new combinations may increase the amount spent per treatment course. The eventual budget impact depends on which cancers and stages qualify, uptake, negotiated prices, manufacturing capacity and the durability of benefit. Success in a common cancer could affect budgets much more than use in a restricted melanoma indication. Total diagnosis counts are not a substitute for an estimate of eligible patients.

Several choices could improve the balance. Negotiating the price of an entire combination would address the cumulative cost of its components. Reassessing reimbursement as survival and real-world evidence mature would reduce reliance on early extrapolations. Trials of shorter schedules could establish whether the same benefit can be achieved with less treatment. Better selection may improve value too, but biomarkers used to determine access need validation.

Patient protection must include indirect expenses and income loss, not only pharmaceutical copayments. Prevention, effective early diagnosis and established cancer services also need sustained funding. Under a constrained budget, spending on a new combination has an opportunity cost: other care that could have been provided with the same resources.

The OECD projection makes the challenge clear before a personalised vaccine is added to any bill. More people will need cancer care as populations age. The test for innovation is whether it delivers enough lasting health benefit to justify its full cost—and whether that benefit can reach patients without overwhelming household finances or displacing more valuable care.

Sources and further reading

1. OECD. Tackling the Impact of Cancer on Health, the Economy and Society (2024), including the health-expenditure projections. Modelling under specified demographic and care assumptions.
2. Merck and Moderna. Phase 3 INTerpath-001 results and treatment schedule (22 October 2026). Company release; overall survival immature, publication announced as accepted.
3. CDC. 2026–27 adult COVID-19 vaccine prices and October 2026 adult vaccine prices. Private-sector prices; not personalised cancer-vaccine quotations.
4. Merck. Keytruda cost, insurance and financial support. US list prices current to September 2026.
5. NICE. Pembrolizumab appraisal TA1037, price section. Public vial price and confidential NHS discount; the appraisal concerns lung cancer.
6. BioNTech. Autogene cevumeran plus atezolizumab and mFOLFIRINOX versus mFOLFIRINOX after pancreatic-cancer resection. Experimental phase 2 regimen.
7. McLean and van Hest. Exploratory cost-effectiveness analysis of V940 plus pembrolizumab. ISPOR Europe 2024 poster; lifetime projections include assumed overall-survival effects.
8. Agence Intermutualiste. Demographic and socioeconomic characteristics of patients receiving immunotherapy. Observational Belgian data; no untreated comparator for the mortality figures discussed here.
9. US National Cancer Institute. Financial Toxicity and Cancer Treatment. Patient-oriented account of financial hardship and its consequences.
10. Financial toxicity and socioeconomic impact of cancer in Europe. ESMO Open 10, 105293 (2025). Multinational patient survey, n = 2,507.
11. Medicare. Original Medicare and Medicare Advantage coverage comparison; CMS, 2026 Part D parameters. Coverage and patient liability depend on the plan and service.

Related posts: Belgian cancer trends · Belgian Keytruda and Opdivo outcomes.

The scenarios and arithmetic in this article are illustrative calculations, not a formal economic evaluation. This article discusses evidence and health policy, not individual treatment decisions.