Cancer Costs May Rise 27% by 2020

The United States will spend at least $158 billion to treat cancer in 2020 – an increase of 27% over 2010, and expensive new tools for diagnoses, treatment, and follow-up could bump the price up to $207 billion, according to a new study by the National Institutes of Health.

The NIH projections, published online this week in the Journal of the National Cancer Institute, were based on the most recent data available on cancer incidence, survival, and costs of care. In 2010, medical costs associated with cancer were projected to reach $127.6 billion, with the highest costs associated with breast cancer ($16.5 billion), colorectal cancer ($14 billion), lymphoma ($12 billion), lung cancer ($12 billion) and prostate cancer ($12 billion).

If cancer incidence and survival rates and costs remain stable and the United States population ages at the rate predicted by the U.S. Census Bureau, direct cancer care expenditures would reach $158 billion in 2020, the report said.

“Rising healthcare costs pose a challenge for policy makers charged with allocating future resources on cancer research, treatment, and prevention,” said study author Angela Mariotto, from NCI’s Surveillance Research Program. “Because it is difficult to anticipate future developments of cancer control technologies and their impact on the burden of cancer, we evaluated a variety of possible scenarios."

Researchers also did additional analyses to account for changes in cancer incidence and survival rates and for the likelihood that cancer care costs will increase as new technologies and treatments are developed.

Assuming a 2% annual increase in medical costs in the initial and final phases of care – which would mirror recent trends – the projected 2020 costs increased to $173 billion. Estimating a 5% annual increase in these costs raised the projection to $207 billion. These figures do not include other types of costs, such as lost productivity, which add to the overall financial burden of cancer.

To project national cancer expenditures, the researchers combined cancer prevalence, the current number of people living with cancer, with average annual costs of care by age (less than 65 or 65 and older). According to those estimates, there were 13.8 million cancer survivors alive in 2010, 58% of whom were age 65 or older. If cancer incidence and survival rates remain stable, the number of cancer survivors in 2020 will increase by 31%, to about 18.1 million. Because of the aging of the U.S. population, the researchers expect the largest increase in cancer survivors over the next 10 years to be among Americans age 65 and older.

"The rising costs of cancer care illustrate how important it is for us to advance the science of cancer prevention and treatment to ensure that we’re using the most effective approaches,” said Robert Croyle, director of the Division of Cancer Control and Population Sciences at the National Cancer Institute. “This is especially important for elderly cancer patients with other complex health problems."

To develop their cost projections, the study used average medical costs for the different phases of cancer care: the first year after diagnosis, the last year of life, and the time in between. For all types of cancer, per-person costs of care were highest in the final year of life.

Per-person costs associated with the first year after a cancer diagnosis were more varied, with cancers of the brain, pancreas, ovaries, esophagus and stomach having the highest initial costs and melanoma, prostate and breast cancers having the lowest initial-year costs.

These new projections are higher than previously published estimates of direct cancer expenditures, largely because the researchers used the most recent data available — including Medicare claims data through 2006, which include payments for newer, more expensive, targeted therapies which attack specific cancer cells and often have fewer side effects than other types of cancer treatments. In addition, by analyzing costs according to phase of care, which revealed the higher costs of care associated with the first year of treatment and last year of life (for those who die from their disease), the researchers were able to generate more precise estimates of the cost of care.

The researchers used 2005 incidence and mortality data from NCI's Surveillance, Epidemiology and End Results program to estimate cancer prevalence for 2010 and 2020.