JNCI: Cancer care costs could exceed $200B by 2020

Clarity image-guided radiation therapy for patient. Image source: Resonant Medical/Elekta

In spite of falling cancer rates nearly across the board, the cost of cancer care in the U.S. is expected to spike by at least 27 percent by 2020, amounting to national expenditures between $155 and $207 billion, according to a study published Jan. 12 in the Journal of the National Cancer Institute.

"We will be spending $158 billion on treating cancer in 2020, assuming no changes in incidence, survival and current costs of care," lead author Angela B. Mariotto, PhD, of the Surveillance Research Program at the National Cancer Institute in Bethesda, Md., told Health Imaging News. "Assuming an increase in costs of 5 percent, these costs increase to $207 billion," Mariotto continued.

While both incidence and survival of cancer have improved in recent years, more expensive technology and changing population dynamics have contributed to increasing treatment costs, with studies projecting these trends to intensify. "Previous estimates of national expenditures for cancer care have mostly been based on older data for incidence, patterns of care, and survival and on inflation adjusted with general medical care inflation adjusters," wrote Mariotto and colleagues.

The researchers estimated the aggregate cost of cancer care in 2020, looking at 13 different cancers in men and 16 in women. Mariotto and colleagues pulled population data and projections from the U.S. Census Bureau.

The authors' projections were based on varying scenarios, including unchanging incidence, survival and cost as well as recent trends involving these three variables, evaluated separately and concertedly. Incidence, survival and cost estimates were based on the Surveillance, Epidemiology, and End Results (SEER) program and Medicare claims.

"The main finding of this study is that costs are likely to increase regardless of changes in incidence, survival and cost, merely because of the fact that the elderly population will be growing," Mariotto commented. According to the authors' base case scenario, assuming no changes in any of the three variables, 2010 national cancer expenditures (estimated at $125 billion) are expected to climb to $158 billion by 2020.

This projection jumps to $173 billion if the costs of treatment rise by 2 percent, and to $207 billion if costs grow by 5 percent. These cost-increasing estimates were based on recent trends in care as well as expected increases in targeted and more expensive chemotherapies.

Female breast cancer and prostate cancer treatment during the middle stages account for the largest growths in expenditures, at 32 percent and 42 percent, respectively. Meanwhile, colorectal cancer accounts for the highest costs in the first year of treatment and lung cancer demands the greatest costs in the final year of care.

With incidence and survival improving for all 16 cancers, except for kidney and melanoma, the authors projected an overall increase in cancer survivors in the U.S. from 13,772,000 in 2010 to 18,071,000 in 2020. "Survival is a good thing," Mariotto explained, "but with earlier detection and extended survival, patients require improved monitoring of the disease, and this, of course, increases cost."

"[C]hanges in incidence and/or survival have a smaller impact on estimates compared with the aging and growth of the U.S. population," Mariotto and colleagues discovered. Assuming no changes in incidence or survival, the most conservative estimate put forth by the authors, expenditures would increase 24 percent to $155 billion. This figure was just $3 billion less than the projection which incorporated the trends of decreasing incidence and increasing survival.

The authors' estimates were higher than those projected in recent studies, including a 2009 study conducted by the National Heart, Lung and Blood Institute (NHLBI), largely because Mariotto and colleagues used more recent trends and pulled data from registries, whereas the NHLBI study based its projections in part on voluntary surveys.

"What we tried to do was provide quantitative assessments of the burden of cancer care, so that policymakers and health planners can prepare for the future and better set priorities," Mariotto explained. Mariotto also said that she did not believe that healthcare reform's expansion of coverage would have any major effect on public expenditures, since 58 percent of cancer survivors are older than 65 years and therefore already receive public funding through Medicare. Moreover, this percentage of senior cancer patients is expected to increase by 2020 as the U.S. population ages.

The authors mentioned several limitations to their study. First, their use of SEER cancer occurrence rates meant that some states were omitted from the analysis. However, according to Mariotto and co-authors, the excluded states are known to have higher incidences of cancer. An additional source of underestimation was the researchers' use of first-tumor diagnoses and claims, so that individuals with multiple tumors may have been undercounted. Mariotto also responded that the authors' use of Medicare-linked claims, rather than costs from all demographics, should not affect the results substantially because this population accounts for the majority of cancer patients.

"Our main findings were that in 2020, we will be spending $158 billion assuming changes only in population. If we assume that costs increase by just 2 percent, this figure increases to $178 billion," Mariotto highlighted.

"It's important for policymakers and health planners to understand the burden, that the aging of the population is likely to increase the cost of cancer care," Mariotto continued. "Managing the costs of new treatments and diagnostic technologies can be one effective way of controlling these increasing costs."