Cancer Care Costs US Billions— Mostly in Drug Expenses

Pennsylvania State University College of Medicine investigators have found that the 15 most prevalent types of cancer in the US cost approximately $156.2 billion in 2018, with medication representing the biggest expense for breast, lung, lymphoma, and colorectal cancers.

The investigators examined a database that included statistics on cancer care for the 402,115 privately insured patients with cancer below the age of 65 in the US. The aim of the study was to gather data to help understand how money is being spent on cancer care, which has traditionally been difficult to track, mainly because the US has different ways to cover health care costs, such as private insurance for people younger than 65 years of age and Medicare for people 65 and over.

“Cancer is a leading cause of death, actually overtaking heart disease as the leading cause of death in the US over the past few years,” said Nicholas Zaorsky, MD, MS, researcher and assistant professor from the departments of radiation oncology and public health sciences at Penn State Cancer Institute, in a statement. “But it’s still unknown what we pay for in cancer care. As a team, we wanted to look at what private insurances are paying for each kind of cancer and for each type of service.”

The investigators assessed a database that included 38.4 million types of Current Procedure Terminology codes for the 15 cancers, including breast, prostate, colorectal, lung, lymphoma, melanoma, uterus, head and neck, bladder, kidney, thyroid, stomach, liver, pancreas, and esophagus cancers. The cohort study used 2018 data, the most recent complete numbers available, from the IBM Watson Health MarketScan.

The sample included 27.1 million privately insured individuals, including patients with the most prevalent cancers.

Breast cancer incurred the most services, about 10.9 million services and procedures, followed by colorectal cancer, which had approximately 3.9 million services listed in the database. Breast cancer was also the most expensive type of cancer, costing a total of $3.4 billion, followed by lung cancer and colorectal cancer, which were both estimated to incur around $1.1 billion in costs.

Drug costs represent the most expensive category for treating patients with cancer. Approximately $4 billion was spent on cancer related drugs, which is twice the $2 billion spent on surgeries. Other direct costs included diagnostic tests, hospital fees, and physician fees.

Pathology and laboratory tests accounted for the highest number of services performed in the study, although the drug therapies cost more than these services.

Investigators noted that these figures highlight discrepancies between the spending associated with different types of cancer but does not offer an explanation to justify these variations.

For example, pancreatic cancer is one of the deadliest cancers, yet the total cost of care devoted to pancreatic cancer is relatively low compared with indolent prostate cancer.

Future research should seek to determine which services are of the most and least value to patients, factors/parameters, etc, that may or may not be directly correlated with higher costs. Furthermore, identifying areas of high out-of-pocket costs will also be an important part of reshaping policy to ease patient burden and improve quality of life for patients with cancer.

REFERENCE

Zaorsky NG, Khunsriraksakul C, Acri SL, et al. Medical service use and charges for cancer care in 2018 for privately insured patients younger than 65 years in the US. JAMA Netw Open. 2021;4(10):e2127784. doi:10.1001/jamanetworkopen.2021.27784