A new analysis of the medical costs of treating cancer in the US shows they have nearly doubled in the last 20 years; they
also reveal a shift away from inpatient to outpatient care, and a rise in the proportion shouldered by private health insurance and
You can read about the study, led by Dr Florence Tangka, a health economist at the Centers for Disease Control and Prevention (CDC), in this week's early online issue of the American Cancer Society journal CANCER.
Tangka and colleagues from the CDC, Emory University, and RTI International hope their findings will help policy makers and budget holders prioritize spending on cancer treatment and prevention.
For their study they analyzed data from two nationally representative telephone surveys: the National Medical Care Expenditure Survey done once in 1987, and 2001 to 2005 data from its successor, the Medical Expenditures Panel Survey.
They found that:
- In 1987, the total medical cost of cancer in the US was $24.7 billion (in 2007 dollars).
- The largest share was borne by private insurance (42 per cent), followed by Medicare (33 per cent).
- Out of pocket expenses accounted for 17 per cent, other public sources 7 per cent, and Medicaid 1 per cent.
- Between 1987 and the 2001-2005 period, the total medical cost of cancer in the US went up to $48.1 billion.
- This increase was due to new cases among an aging population and increased prevalence of cancer.
- In 2001-2005, the largest share of the cost was borne by private insurance (50 per cent), followed by Medicare (34 per cent).
- Out of pocket expenses accounted for 8 per cent, other public sources 5 per cent, and Medicaid 3 per cent.
- The proportion of total cancer medical costs incurred after inpatient admission fell from 64.4 per cent in 1987 to 27.5 per cent in 2001-2005.
- This was accompanied by an increase in cancer-related outpatient costs.
The researchers cautioned that their figures don't reflect areas where costs could have been even greater, for instance people in long term care facilities, and people with advanced disease.
Tangka told the media these findings should help us better understand who pays for what in cancer prevention and treatment and how health reform and changes to financing and delivering health care affects the balance.
She and her colleagues also noted that further research was needed to find out how these changes might affect costs and quality of cancer care in the US.
The findings appear to have come as a surprise to some experts, who would have expected such a study to find cost of drugs rather than rise in patient numbers to be the main reason for driving up the cost of cancer care.
Another surprise finding was that as a proportion of the total cost of medical care in the US, cancer care has remained at around 5 per cent for the last 20 years.
While not disputing the findings, Dr Len Lichtenfeld of the American Cancer Society told ABC News he was "a bit surprised" by them: he would have expected a rise in the cancer care share of the total US medical cost of healthcare.
Reflecting on the value for money aspect of the increased cost of cancer care, Kenneth Thorpe, a health policy researcher at Emory University, said the increased spending represents money better spent because we now have better and more advanced treatments that are helping to keep more people alive:
"It seems like we're buying increases in survival," said Thorpe, according to an ABC News report.
"Cancer treatment cost in the United States: has the burden shifted over time?"
Florence K. Tangka, Justin G. Trogdon, Lisa C. Richardson, David Howard, Susan A. Sabatino, and Eric A. Finkelstein.
CANCER, Published Online: May 10, 2010.
Source: American Cancer Society, ABC News.
Written by: Catharine Paddock, PhD