Background
Large national expenditure on cancer is not always associated with lower cancer mortality.  Reasons for this can include late diagnosis, spending inefficiencies including high prices, and an overfocus on treatment at the expense of prevention.  Cancer prevention and early screening programs are linked to lower cancer mortality. However, direct medical expenditure on cancer and its components are not readily available for most of the countries in Eastern Europe, Caucasus and Central Asia (EECCA). Some studies reviewed health authority’s websites and found some nationally reported data. Others relied on the peer-reviewed literature and modelling based on data from other countries. In this study, we review the latest data available on health authority’s websites and reach out to authorities to obtain missing data.

Objectives
To collect nationally reported data on cancer expenditure and to examine its relationship with mortality in 15 EECCA countries. To conduct sub-analyses in countries with data on time trends and different components of direct expenditure like prevention and screening programs and pharmaceuticals. 

Methods
This was a cross-sectional ecological study. In November-December 2025, we reviewed websites of health authorities in 15 out of 28 EECCA countries for the latest data (2024 or earlier) on direct national expenditure on cancer. Additionally, we reviewed the grey literature. We adjusted cancer expenditure data for inflation and converted it to USD at purchasing power parity (PPP) using World Bank data. We used 5-year prevalence data from the GLOBOCAN database as a proxy for the number of cases treated in a particular year. Mortality to Incidence Ratio (MIR) was also obtained from the GLOBOCAN database and plotted against per cancer case expenditure. Expenditure for pharmaceuticals and prevention programs, and time trends were analysed when available. Spearman’s rank correlation was used to test the relationship between expenditure and MIR. 

Results
Direct cancer expenditure per cancer case ranged from 1,400 USD PPP in Kyrgyzstan to 16,400 USD PPP in Lithuania. There was no significant correlation between increasing per-cancer-case expenditure and mortality (p=0.12). However, higher expenditure per capita correlated with lower cancer mortality (r=0.8, p=0.002). There was a strong, albeit nonsignificant, inverse correlation between increased spending on cancer screening and increased mortality (r=-0.7, p=0.23). In four countries longitudinal data was available from 2017 onwards. In Kazakhstan, cancer expenditure doubled over six years growing from 530 million USD PPP to 1.2 billion USD PPP. In Moldova expenditure on cancer increased by 20% over 5 years. In the six countries with available data on pharmaceutical expenditure on cancer, this represented between 20% and 51% of total cancer expenditure.  

Conclusions/Implications for practice or policy
There was limited data on cancer expenditure in EECCA countries despite cancer bearing significant costs. Expenditure on prevention was limited to Eastern European countries. The insignificant but apparent correlation between increased prevention spending and reduced mortality on five countries call for more research on prevention in EECCA countries.