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Projections of the Cost of Cancer Care in the United States: 2010-2020
By gdpawel at 2011-01-13 22:24
Projections of the Cost of Cancer Care in the United States: 2010-2020

Projections of the Cost of Cancer Care in the United States: 2010-2020

Angela B. Mariotto, K. Robin Yabroff, Yongwu Shao, Eric J. Feuer and Martin L. Brown

Angela B. Mariotto, PhD, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Ste 504, MSC 8317, 6116 Executive Blvd, MSC 7344, Bethesda, MD 20892-7344
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.

JNCI J Natl Cancer Inst 10.1093/jnci/djq495

http://jnci.oxfordjournals.org/content/early/2011/01/12/jnci.djq495.full



16 comments | 17447 reads

by gdpawel on Thu, 2011-01-13 22:45
It's been pointed out that the increase is influenced by a projected rise in the number of prostate and breast cancer patients. Ironically, these are the very two cancers presently involved with the early cancer detection controversy, that is raising uncomfortable questions about how aggressively to treat early growths and in some cases, even how aggressively to test.

Today's cancer screenings can unearth tumors that scientists say never would have threatened the person's life. The problem is there are not surefire ways to tell in advance which tumors won't be dangerous. Even the staunchest supporters of screening call overdiagnosis a problem that needs tackling.

Nowhere is the disconnect more obvious than with prostate and breast cancer screening. Researchers have reminded us that a lack of solid evidence doesn't seem to hamper doctors' use of new technology as long as they can get reimbursed for it.

New targeted treatments and diagnostics are likely to be more expensive that what is already available now. It is suspected that those costs might be mitigated somewhat through the use of genomic-based prognostic markers to more accurately match therapies with those likely to respond.

However, as the NCI has concluded (J Natl Cancer Inst. March 16, 2010), these genomic-based technologies cannot determine treatment plans for patients. It cannot test sensitivity to any of the targeted therapies. They just test for "theoretical" candidates for targeted therapy.

Cancer dynamics are not linear, Cancer biology does not conform to the dictates of molecular biology. We are forced to confront the realization that genotype does not equal phenotype. Cancer cells utilize cross talk and redundancy to circumvent therapies. They back up, zig-zag and move in reverse, regardless of what the sign posts say. The building blocks of human biology are carefully construed into the complexities that we recognize as human beings.

However appealing gene profiling may appear to those engaged in this field, it will be years, perhaps decades, before these profiles can approximate the vagaries of human cancer.

Functional profiling analyses, which measure biological signals rather than DNA indicators, will continue to provide clinically validated information and play an important role in cancer drug selection. The data that support functional profiling analyses is demonstrably greater and more compelling than any data currently generated from DNA analyses. Functional profiling remains the most validated technique for selecting effective therapies for cancer patients.

Functional profiling assesses the activity of a drug upon combined effect of all cellular processes, using several metabolic (cell metabolism) and morphologic (structure) endpoints, at the cell "population" level, rather than at the "single cell" level, measuring the interaction of the entire genome.

The original Human Genome Project (the world's most expensive telephone book*) dealt with a homogeneous population of normal diploid cells. This is different from primary tumors, which are heterogeneous and have a genomic signature unique to each and every patient. Functional profiling is a biomarker of heterogeneous cancer cells and genomic signatures unique to every individual patient.

* The sequencing of the entire human genome gave us the address and the next door neighbors of every human gene, yet we don't know what they do, how they do it, why they do it, or who they do it with. - Dr. Robert A. Nagourney

Sources:
JNCI J Natl Cancer Inst (2010) doi: 10.1093/jnci/djq306
Eur J Clin Invest, Volume 37(suppl. 1):60, April 2007
BMJ 2007;334(suppl 1):s18 (6 January), doi:10.1136/bmj.39034.719942.94

by gdpawel on Fri, 2011-01-14 01:32
How Long and How Well: Oncologists' Attitudes Toward the Relative Value of Life-Prolonging v. Quality of Life-Enhancing Treatments

Drugs that help cancer patients live longer are worth more for oncologists than drugs that help patients live well, according to a research by Duke University's Fuqua School of Business and several health-related centers.

On an average, oncologists are willing to prescribe treatments that cost almost $245,000 to prolong life for one year, but the cost threshold dropped to about $119,000 per year for treatments that improve quality of life, without prolonging patients' lives.

The study results are based on a survey of 768 physicians, considered two hypothetical scenarios involving a patient with metastatic cancer and a year to live. The first scenario asked the doctor how much benefit, in months of survival gained, a new drug would need to provide for them to prescribe it. The new drug cost about $75,000 more than standard treatment. The second scenario asked the doctor to indicate the highest cost at which they would prescribe a medication to improve the quality of life without prolonging survival.

The respondents consistently chose to spend more on life-prolonging treatments than on quality-enhancing treatments.

"Oncologists are understandably focused on survival, but they need to pay equal attention to the quality of life that people experience during and after treatment," said senior author Peter Ubel, a professor of business administration at Duke University's Fuqua School of Business.

The researchers also found a wide range in what cancer doctors considered reasonable treatment costs. The threshold varied from about $10,000 to about $5 million per quality adjusted life year (QALY), a standard for assessing the cost-effectiveness of medical interventions. The spending thresholds assessed in the study were also measured in QALYs.

The results highlight a critical problem in the struggle to control health care costs, Ubel said. Increasingly, doctors are being asked to consider whether very expensive cancer drugs - some of which offer only small gains in survival - are worth prescribing. But according to Ubel, the data on cost-effectiveness comes without guidelines for determining appropriate financial value in cancer care.

"Currently, individual oncologists are left to decide whether the benefits of expensive new drugs justify their costs," said Ubel. "Cancer care spending is unlikely to drop when there is such a broad range in what oncologists consider reasonable."

"The fact that these highly trained, wonderful doctors are confused about the issue is reason enough to reinforce the dialogue on the cost of cancer care explicitly. With health care spending emptying patients' pocketbooks, and putting pressure on governments worldwide, we need to decide how much we should spend for small improvements in the quantity or quality of patients' lives."

Additional authors of the study include Michael A. Kozminski and Aleksandra Jankovic of the Center for Behavioral and Decision Sciences in Medicine, University of Michigan Medical School in Ann Arbor, Mich.; Peter J. Neuman of the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center in Boston; and Eric S. Nadler of the Charles Sammons Cancer Center, Baylor University Medical Center in Dallas.

Source: Duke University's Fuqua School of Business

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