Projections of The Cost of Cancer Care in 2020
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>> My name is Angela Mariotto, I'm Acting Branch Chief
of the Data Modeling Branch
of the Surveillance Research Program at Division
of Cancer Control and Population Sciences NCI.
>> My name is Robin Yabroff and I'm an epidemiologist
in the Health Services and Economics Branch
at the National Cancer Institute.
>> In 2010 we expect that the cost
of cancer care will be 125 billion dollars
and if we assume no changes in incident survival
and cost these cost estimates will be 158 billion dollars
in 2020, representing a 27 percent increase
in the cost of cancer care.
So it's important to notice
that these increases represents only the aging and growth
of the U.S. population.
But in this study we also produced estimates
under different scenario [inaudible] for incidents
and survival and cost trends.
If incidents and survival trends
and cost trends we continue observing the last few years
of data.
The estimates can rise up to 207 billion dollars
which will represents 66 percent increase.
>> So there's a lot of uncertainty about how costs
of care are increasing.
We do know that they're going up but there's uncertainty
in relation to how much patients are using new targeted
therapies, how much they're using hospitalizations,
so what we did
in our projections is we evaluated a range
of possibilities including one possibility where we assumed
that costs remained the same as what they were,
one that we assumed that costs increased by 2 percent
in the initial period following diagnosis and then at the end
of life period and then another scenario where we assume
that the cost of care increased by 5 percent
in the initial period following diagnosis
and at the end of life period.
We based these estimates on prior work where we looked
at trends and expenditures for breast, prostate, colorectal
and lung cancer patients and we saw that there were increases
over time but it's driven by different components
so for example with chemotherapy
in colorectal cancer increased quite a bit from the years 1991
to 2002 which is the period that we were evaluating,
for colorectal cancer but not quite as much
for some of the other cancers.
So we based our estimates on the best information we had
but we're also actively looking at trying to update some
of these estimates to try and understand what's going
on right now in terms of treatment patterns
and also expenditures.
We are planning on updating our estimates based
on cancer patients diagnosed for the year 2007 as soon
as those data become available.
>> Coincidentally 2011 represents the first year
that the first generation of the baby boomers will reach 65 years
and as we mentioned before the aging
of the U.S. population is the biggest factor influencing the
trends in cancer costs.
So the idea was to provide some numbers for policy makers
and health planners so they can better set priorities
and plan for the future.
We use the data from multiple sources
and we use the most recent data available.
We used the cancer incident and survival
from the SEER cancer registries and we use claims data
from the SEER-Medicare data which is claims data
from Medicare linked to cancer patients in the SEER program.
And we also used similar data, claims data for patients
without cancer and the comparison provided estimates
of the costs associated with only the cancer treatment
and we used the U.S. population projections from the U.S. census
to provide our future U.S. populations.
I'm a statistician and in this work I work
with epidemiologist health services researchers
and economies and I think with the combination of expertise
that made this work more interesting and important.
For example if we just have produced cancer prevalence
projections and used the expertise
of the statisticians only then impact would be not as important
as projecting cost as well.
>> The rising health care cost represent a big challenge
for health care policy makers for the Medicare program
and also for health care delivery systems and one
of the important things about doing projections is it helps us
to understand the relative impact
of different types of trends.
So for example changes in incidents, changes in survival,
changes in population, population growth and aging
but also what we might expect would happen
with new treatments, new diagnostic technologies
and other types of things that might affect costs.
So because the National Cancer Institute is so interested
in trying to understand the impact of trends on the burden
of cancer, this is an important area
for us to be doing research.
It also helps us to identify issues where we might want
to try and understand better how it might be impacting costs
in the future.
