Projections of the cost of cancer care in the United States: 2010-2020

Abstract

Background: Current estimates of the costs of cancer care in the United States are based on data from 2003 and earlier. However, incidence, survival, and practice patterns have been changing for the majority of cancers.

Methods: Cancer prevalence was estimated and projected by phase of care (initial year following diagnosis, continuing, and last year of life) and tumor site for 13 cancers in men and 16 cancers in women through 2020. Cancer prevalence was calculated from cancer incidence and survival models estimated from Surveillance, Epidemiology, and End Results (SEER) Program data. Annualized net costs were estimated from recent SEER-Medicare linkage data, which included claims through 2006 among beneficiaries aged 65 years and older with a cancer diagnosis. Control subjects without cancer were identified from a 5% random sample of all Medicare beneficiaries residing in the SEER areas to adjust for expenditures not related to cancer. All cost estimates were adjusted to 2010 dollars. Different scenarios for assumptions about future trends in incidence, survival, and cost were assessed with sensitivity analysis.

Results: Assuming constant incidence, survival, and cost, we projected 13.8 and 18.1 million cancer survivors in 2010 and 2020, respectively, with associated costs of cancer care of 124.57 and 157.77 billion 2010 US dollars. This 27% increase in medical costs reflects US population changes only. The largest increases were in the continuing phase of care for prostate cancer (42%) and female breast cancer (32%). Projections of current trends in incidence (declining) and survival (increasing) had small effects on 2020 estimates. However, if costs of care increase annually by 2% in the initial and last year of life phases of care, the total cost in 2020 is projected to be $173 billion, which represents a 39% increase from 2010.

Conclusions: The national cost of cancer care is substantial and expected to increase because of population changes alone. Our findings have implications for policy makers in planning and allocation of resources.

Figures

Figure 1

Observed age-adjusted incidence (solid circles) and projected age-adjusted incidence under the assumption of future constant incidence (open circles) and continuing incidence trend (asterisks). The number represents the estimated annual percent change from 1996 through 2005.

Figure 2

Fit of the survival model to observed data. Observed (solid circles [10-year] and asterisks [5-year]) and modeled (solid line [5-year] and dashed line [10-year]) relative survival trends for the major cancer sites for people diagnosed between the ages of 65 and 74 years.

Figure 3

Estimates of the national expenditures for cancer care in 2010 (light gray areas) and the estimated increase in cost in 2020 (dark gray areas) because of the aging and growth of the US population under assumptions of constant incidence survival and cost for the major cancer sites. Costs in 2010 billion US dollars by phase of care: initial year after diagnosis (Ini.) continuing care (Con.) and last year of life (Last).