Cost of Cancer Care Projected to Rise Significantly in Next Decade

According to a recent report, the costs associated with cancer care in the United States are predicted to reach at least $157.77 billion by 2020 and may be much higher based on elderly population growth, higher rates of survival, and escalating chemotherapy and cancer treatment costs. The projection represents a 27% increase compared with cancer care costs in 2010, but it assumes stable incidence and survival rates and costs between 2010 and 2020 and only reflects population growth projections. The authors considered other scenarios, including assuming costs of care would increase by 2% to 5% from 2010 to 2020 in the initial year following diagnosis and the last year of life. In those cases, the 2020 costs would be between $172.77 billion and $206.59 billion. The results were published in the Journal of the National Cancer Institute [2011;103(1):1-12]. The National Cancer Institute is part of the National Institutes of Health. The authors examined 13 cancers in men and 16 cancers in women by tumor site and phase of care. They used the Surveillance, Epidemiology, and End Results (SEER) program to obtain cancer incidence, survival, all-cause mortality, and population data from 1975 through 2005. They also visited the US Census Bureau’s Web site for population projections from 2006 through 2010. Patients were included in the study if they had a cancer diagnosis through SEER between 1975 and 2005 and were ≥65 years of age between 2001 and 2006. The authors estimated costs using Medicare claims data linked to SEER data, which included diagnoses through 2005. The control group included noncancer patients found through a 5% random sample of Medicare beneficiaries living in areas where SEER data are compiled. The analysis grouped patients in 3 categories: the first 12 months following diagnosis (initial period), the final 12 months of life (last year of life period), and the months in between (continuing period). If patients survived <24 months, the authors assigned the months of survival to the last year of life period and the remaining months of observation to the initial period. If patients survived <12 months, the authors assigned the months of survival to the last year of life period. Regardless of cancer site, the costs were highest in the last year of life period. The initial period’s costs varied depending on the cancer site, with brain, pancreas, ovary, esophagus, and stomach cancers having the highest cost and melanoma, prostate, and breast cancers having the lowest cost. The study included 390,683 patients in the initial period, 926,793 in the continuing period, and 475,750 in the last year of life period. The authors randomly assigned the control group to a diagnosis date that matched 1 of the cancer patients and matched the groups by sex, age group (65-69, 70-74, 75-79, and ≥80 years), and SEER area strata. When considering the cost of care for cancer patients <65 years of age, the authors examined published studies in managed care settings that contained ratios of the costs of elderly patients and those <65 years of age. In this study, the authors assumed the annual net medical costs for patients <65 years of age were 1.2 times and 1.5 times the costs for elderly patients in the initial period and last year of life period, respectively. For the continuing period, the costs were assumed to be the same for the 2 groups. In their base scenario, the authors held cancer costs, incidence, and survival rates constant between 2010 and 2020. They estimated there were 13,772,000 cancer survivors (including 58% <65 years of age) in 2010 compared with a projected 18,071,000 (including 63% <65 years of age) in 2020. The scenario also estimated the annual national cost of cancer care at $124.57 billion in 2010, with female breast cancer ($16.50 billion), colorectal cancer ($14.14 billion), lymphoma ($12.14 billion), lung cancer ($12.12 billion), and prostate cancer ($11.85 billion) as the most costly sites. In 2020, the costs are projected to rise to $157.77 billion, which only reflects population growth and aging of current cancer patients. The study also included a scenario in which the authors used the incidence trends from 1996 through 2005 and estimated the annual percent change from 2006 through 2020. In that case, the projected cost of cancer care in 2020 would be $147.57 billion, which is lower than the base case because the incidence of many cancers is decreasing. Another scenario accounting for recent survival trends found the cost in 2020 would be $165.21 billion. When the authors combined the incidence trends and survival trends assumptions, the 2020 cost was estimated at $154.70 billion. In other scenarios, the authors assumed a 2% annual increase in costs for all phases of care, a 2% annual increase in the initial and last year periods, and a 5% annual increase in the initial and last year periods. The projected costs in those cases would be $186.69 billion, $172.77 billion, and $206.59 billion, respectively. The authors indicated the report contained a few possible limitations. To estimate cancer prevalence, they used incidence and survival data from SEER areas. However, SEER areas are only in certain regions of the United States and have lower incidence rates, higher socioeconomic status, greater urban population, and more specialty care than non-SEER areas. The authors also noted that prevalence and cost estimates based on the first tumor diagnosis may be underestimated because some people have multiple tumors. In addition, the study did not control for other diseases. The authors said that if the cancer patients and control subjects had the same prevalence of noncancer diseases, the difference in prevalence was only associated with cancer. If cancer patients have a higher prevalence of noncancer diseases, the cost differences can be attributed to other diseases.