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Costs of cancer care in the USA: a descriptive review

Nature Clinical Practice Oncology volume 4, pages 643–656 (2007)Cite this article

Abstract

Although many studies assessing the cost of cancer care have been conducted in the US, to date, these studies and the underlying methods used to estimate costs have not been reviewed systematically. We conducted a descriptive review of the published literature on the cost of cancer care in the US, and identified 60 papers published between 1995 and 2006 pertinent to our study. We found heterogeneity across the studies in terms of the settings, populations studied, measurement of costs, and study methods. We also identified limitations in the generalizability of findings, the misclassification of patient groups and costs, and concerns with study methods. Among studies that reported costs of cancer care in multiple phases of care and for multiple tumor sites, costs were generally highest in the initial year following diagnosis and the last year of life, and lower in the continuing phase (i.e. the period between the initial and last year of life phases), following a 'u-shaped' curve. Within phase of care, costs for lung and colorectal cancer care were generally higher than those for breast and prostate cancer care, however, the long-term or lifetime costs for each type of cancer were more similar, reflecting the differences in survival and costs in each phase between the different disease types.

Key Points

  • Studies of the cost of cancer care in the US are heterogeneous in relation to the study settings, populations studied, measurement of costs, and study methods

  • The cost of cancer care in the US is substantial

  • Among studies that reported costs of cancer care in multiple phases of care and for several types of cancer, costs were generally highest in the initial year following diagnosis and the last year of life, and lower in the continuing phase, following a 'u-shaped' curve

  • Although within phase of care, costs for lung and colorectal cancer care were generally higher than those for breast and prostate cancer care, long-term or lifetime costs were similar, reflecting differences in survival and phase-specific costs between the tumor sites

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References

  1. Ries LA et al. (2005) SEER Cancer Statistic Review, 1975–2002. National Cancer Institute: Bethesda MD

    Google Scholar 

  2. Brown ML and Yabroff KR (2006) Economic impact of cancer in the United States. In: Cancer Epidemiology and Prevention 202–214 (Eds Schottenfeld D and Faumeni JF) New York, NY: Oxford University Press

    Chapter  Google Scholar 

  3. National Cancer Institute, NIH, DHHS (2007) Cancer Trends Progress Report—2005 Update. Bethesda, MD: National Cancer Institute

  4. Brown ML et al. (2002) Estimating health care costs related to cancer treatment from SEER-Medicare data. Med Care 40 (8 Suppl): 104–117

    Google Scholar 

  5. Elixhauser A and Halpern MT (1999) Economic evaluations of gastric and pancreatic cancer. Hepatogastroenterology 46: 1206–1213

    CAS  PubMed  Google Scholar 

  6. Goodwin PJ and Shepherd FA (1998) Economic issues in lung cancer: a review. J Clin Oncol 16: 3900–3912

    Article  CAS  Google Scholar 

  7. Ruchlin HS and Pellissier JM (2001) An economic overview of prostate carcinoma. Cancer 92: 2796–2810

    Article  CAS  Google Scholar 

  8. Taplin SH et al. (1995) Stage, age, comorbidity, and direct costs of colon, prostate, and breast cancer care. J Natl Cancer Inst 87: 417–426

    Article  CAS  Google Scholar 

  9. Penberthy L et al. (1999) Predictors of Medicare costs in elderly beneficiaries with breast, colorectal, lung, or prostate cancer. Health Care Manag Sci 2: 149–160

    Article  CAS  Google Scholar 

  10. Thorpe KE and Howard D (2003) Health insurance and spending among cancer patients. Health Aff (Millwood) (Suppl Web Exclusive): W3–189–W3–198

  11. Langa KM et al. (2004) Out-of-pocket health care expenditures among older Americans with cancer. Value Health 7: 186–194

    Article  Google Scholar 

  12. Polednak AP and Shevchenko IP (1998) Hospital charges for terminal care of cancer patients dying before age 65. Health Care Financ Rev 25: 26–34

    CAS  Google Scholar 

  13. Fireman BH et al. (1997) Cost of care for cancer in a health maintenance organization. Health Care Financ Rev 18: 51–76

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Howard DH et al. (2004) National estimates of medical costs incurred by nonelderly cancer patients. Cancer 100: 883–891

    Article  Google Scholar 

  15. Chang S et al. (2004) Estimating the cost of cancer: results on the basis of claims data analyses for cancer patients diagnosed with seven types of cancer during 1999 to 2000. J Clin Oncol 22: 3524–3530

    Article  Google Scholar 

  16. Mullins CD et al. (2004) Economic disparities in treatment costs among ambulatory Medicaid cancer patients. J Natl Med Assoc 96: 1565–1574

    PubMed  PubMed Central  Google Scholar 

  17. Warren JL et al. (2001) Costs of treatment for elderly women with early-stage breast cancer in fee-for-service settings. J Clin Oncol 20: 307–316

    Article  Google Scholar 

  18. Given C et al. (2001) Observation interval for evaluating the costs of surgical interventions for older women with a new diagnosis of breast cancer. Med Care 39: 1146–1157

    Article  CAS  Google Scholar 

  19. Oestreicher N et al. (2005) The cost of adjuvant chemotherapy in patients with early-stage breast carcinoma. Cancer 104: 2054–2062

    Article  Google Scholar 

  20. Barlow WE et al. (2001) Cost comparison of mastectomy versus breast-conserving therapy for early stage breast cancer. J Natl Cancer Inst 93: 447–455

    Article  CAS  Google Scholar 

  21. Tollestrup K et al. (2001) The excess cost of breast cancer health care in Hispanic and non-Hispanic female members of a managed care organizatoin. Breast Cancer Res Treat 66: 25–31

    Article  CAS  Google Scholar 

  22. Sasser AC et al. (2005) Economic burden of osteoporosis, breast cancer, and cardiovascular disease among postmenopausal women in an employed population. Women's Health Issues 15: 97–108

    Article  Google Scholar 

  23. Rao S et al. (2004) Cost of illness associated with metastatic breast cancer. Breast Cancer Res Treat 83: 25–32

    Article  CAS  Google Scholar 

  24. Arozullah AM et al. (2004) The financial burden of cancer: estimates from a study of insured women with breast cancer. J Support Oncol 2: 271–278

    PubMed  Google Scholar 

  25. Brown ML et al. (1999) Obtaining long-term disease specific costs of care: application to Medicare enrollees diagnosed with colorectal cancer. Med Care 37: 1249–1259

    Article  CAS  Google Scholar 

  26. Ramsey SD et al. (2002) Lifetime cancer-attributable cost of care for long term survivors of colorectal cancer. Am J Gastroenterol 97: 440–445

    Article  Google Scholar 

  27. Etzioni R et al. (2001) The impact of including future medical care costs when estimating the costs attributable to disease: a colorectal cancer case study. Health Econ 10: 245–256

    Article  CAS  Google Scholar 

  28. Kerrigan M et al. (2005) Costs and survival of patients with colorectal cancer in a health maintenance organization and a preferred provider organization. Med Care 43: 1043–1048

    Article  Google Scholar 

  29. Seifeldin R and Hantsch JJ (1999) The economic burden associated with colon cancer in the United States. Clin Ther 21: 1370–1379

    Article  CAS  Google Scholar 

  30. Ramsey SD et al. (2004) Chemotherapy use, outcomes, and costs for older persons with advanced non-small cell lung cancer: evidence from Surveillance, Epidemiology and End Results-Medicare. J Clin Oncol 22: 4971–4978

    Article  Google Scholar 

  31. Hillner BE et al. (1998) Costs of care associated with non-small-cell lung cancer in a commercially insured cohort. J Clin Oncol 16: 1420–1424

    Article  CAS  Google Scholar 

  32. Kutikova L et al. (2005) The economic burden of lung cancer and the associated costs of treatment failure. Lung Cancer 50: 143–154

    Article  Google Scholar 

  33. Hoverman JR and Roberston SM (2004) Lung cancer: a cost and outcome study based on physician practice patterns. Dis Manag 7: 112–123

    Article  Google Scholar 

  34. Burkhardt JH et al. (2002) Comparing the costs of radiation therapy and radical prostatectomy for the initial treatment of early-stage prostate cancer. J Clin Oncol 20: 2869–2875

    Article  Google Scholar 

  35. Penson DF et al. (2004) The economic burden of metastatic and prostate specific antigen progression in patients with prostate cancer: findings from a retrospective analysis of health plan data. J Urol 171: 2250–2254

    Article  Google Scholar 

  36. Brandeis J et al. (2000) A nationwide charge comparison of the principal treatments for early stage prostate carcinoma. Cancer 89: 1792–1799

    Article  CAS  Google Scholar 

  37. Max W et al. (2002) The economic burden of prostate cancer, California, 1998. Cancer 94: 2906–2913

    Article  Google Scholar 

  38. Kramolowsky EV et al. (1995) The role of the physician in effecting change in hospital charge for radical prostatectomy. J Am Coll Surg 180: 513–518

    CAS  PubMed  Google Scholar 

  39. Jayadevappa R et al. (2005) Medical care costs of patients with prostate cancer. Urol Oncol 23: 155–162

    Article  Google Scholar 

  40. Dimick JB et al. (2006) Hospital volume is related to clinical and economic outcomes of esophageal resection in Maryland. Ann Thorac Surg 72: 334–341

    Article  Google Scholar 

  41. Rizzo JD et al. (1999) Outpatient-based bone marrow transplantation for hematologic malignancies: cost saving or cost shifting? J Clin Oncol 17: 2811–2818

    Article  CAS  Google Scholar 

  42. Etzioni R et al. (1996) Estimating the costs attributable to a disease with application to ovarian cancer. J Clin Epidemiol 49: 95–103

    Article  CAS  Google Scholar 

  43. Chang S et al. (2006) Burden of pancreatic cancer and disease progression: economic analysis in the US. Oncology 70: 71–80

    Article  Google Scholar 

  44. Green DM et al. (1998) Effect of duration of treatment on treatment outcome and cost of treatment for Wilms' tumor: a report from the National Wilms' Tumor Study Group. J Clin Oncol 16: 3744–3751

    Article  CAS  Google Scholar 

  45. Ramsey SD et al. (2002) Economic analysis of vinorelbine plus cisplatin versus paclitaxel plus carboplatin for advanced non-small-cell lung cancer. J Natl Cancer Inst 94: 291–297

    Article  Google Scholar 

  46. Hensley ML et al. (2005) Economic outcomes of breast cancer survivorship: CALGB study 79804. Breast Cancer Res Treat 91: 153–161

    Article  Google Scholar 

  47. Ritz LJ et al. (2000) Effects of advanced nursing care on quality of life and cost outcomes of women diagnosed with breast cancer. Oncol Nurs Forum 27: 923–932

    CAS  PubMed  Google Scholar 

  48. Brown ML et al. (2001) The burden of illness in cancer: economic cost and quality of life. Ann Rev Public Health 22: 91–113

    Article  CAS  Google Scholar 

  49. Dickersin K et al. (1994) Identifying relevant studies for systematic reviews. BMJ 309: 1286–1291

    Article  CAS  Google Scholar 

  50. Ray GT et al. (2000) The cost of health conditions in a health maintenance organization. Med Care Res Rev 57: 92–109

    Article  CAS  Google Scholar 

  51. Fishman P et al. (1997) Chronic care costs in managed care. Health Aff (Millwood) 16: 239–247

    Article  CAS  Google Scholar 

  52. Riley GF et al. (1995) Medicare payments from diagnosis to death for elderly cancer patients by stage and diagnosis. Med Care 33: 828–841

    Article  CAS  Google Scholar 

  53. Desch CE et al. (1999) A sociodemographic and economic comparison of breast reconstruction, mastectomy, and conservative surgery. Surgery 125: 441–447

    Article  CAS  Google Scholar 

  54. Legorreta AP et al. (1996) Cost of breast cancer treatment: a 4-year longitudinal study. Arch Intern Med 156: 2197–2201

    Article  CAS  Google Scholar 

  55. Lamerato L et al. (2006) Economic burden associated with breast cancer recurrence: findings from a retrospective analysis of health system data. Cancer 106: 1875–1882

    Article  Google Scholar 

  56. Polednak AP et al. (1996) Estimating breast cancer treatment charges in Connecticut. Conn Med 60: 263–267

    CAS  PubMed  Google Scholar 

  57. Ramsey SD et al. (2003) Cancer-attributable costs of diagnosis and care for persons with screen-detected versus symptom-detected colorectal cancer. Gastroenterology 125: 1645–1650

    Article  Google Scholar 

  58. Paramore LC et al. (2006) Estimating costs of care for patients with newly diagnosed metastatic colorectal cancer. Clin Colorectal Cancer 6: 52–58

    Article  Google Scholar 

  59. Au DH et al. (2006) Differences in health care utilization at the end of life among patients with chronic obstructive pulmonary disease and patients with lung cancer. Arch Intern Med 166: 326–331

    Article  Google Scholar 

  60. Penson DF et al. (2001) Relationship of first-year costs of treating localized prostate cancer to initial choice of therapy and stage at diagnosis: results from the CaPSURE database. Urology 57: 499–503

    Article  CAS  Google Scholar 

  61. Litwin MS et al. (1998) Epidemiological trends and financial outcomes in radical prostatectomy among Medicare beneficiaries, 1991 to 1993. J Urology 160: 445–448

    Article  CAS  Google Scholar 

  62. Benoit RM et al. (1998) Comparison of the hospital costs for radical prostatectomy and cryosurgical ablation of the prostate. Urology 52: 820–824

    Article  CAS  Google Scholar 

  63. Lang K et al. (2004) The economic cost of squamous cell cancer of the head and neck. Arch Otolaryngol Head Neck Surg 130: 1269–1275

    Article  Google Scholar 

  64. Du W et al. (2000) Cost analysis of pancreatic carcinoma treatment. Cancer 89: 1917–1924

    Article  CAS  Google Scholar 

  65. Max W et al. (2003) The economic burden of gynecologic cancers in California, 1998. Gynecol Oncol 88: 96–103

    Article  Google Scholar 

  66. Hillner BE et al. (2001) Burden of illness associated with metastatic melanoma: an audit of 100 consecutive referral center cases. Cancer 91: 1814–1821

    Article  CAS  Google Scholar 

  67. Menzin J et al. (2004) Treatment patterns, outcomes and costs among elderly patients with chronic myeloid leukaemia: a population-based analysis. Drugs Aging 21: 737–746

    Article  Google Scholar 

  68. Menzin J et al. (2002) The outcomes and costs of acute myeloid leukemia among the elderly. Arch Intern Med 162: 1597–1603

    Article  Google Scholar 

  69. Bennett CL et al. (1995) Costs of care and outcomes for high-dose therapy and autologous transplantation for lymphoid malignancies: results from the University of Nebraska 1987 through 1991. J Clin Oncol 13: 969–973

    Article  CAS  Google Scholar 

  70. Finkler SA (1982) The distinction between cost and charges. Ann Intern Med 96: 102–109

    Article  CAS  Google Scholar 

  71. Mandelblatt J et al. (2004) Descriptive review of the literature on breast cancer outcomes: 1990 through 2000. J Natl Cancer Inst Monogr 33: 8–44

    Article  Google Scholar 

  72. Yabroff KR et al. (2007) Patient time costs associated with cancer care. J Natl Cancer Inst 99: 14–23

    Article  Google Scholar 

  73. Hayman JA et al. (2001) Estimating the cost of informal caregiving for elderly patients with cancer. J Clin Oncol 19: 3219–3225

    Article  CAS  Google Scholar 

  74. Bradley CJ et al. (2005) Employment outcomes of men treated for prostate cancer. J Natl Cancer Inst 97: 958–965

    Article  Google Scholar 

  75. Bach PB et al. (2004) Resurrecting treatment histories of dead patients: a study design that should be laid to rest. JAMA 292: 2765–2770

    Article  CAS  Google Scholar 

  76. Schrag D (2004) The price tag on progress—chemotherapy for colorectal cancer. N Engl J Med 351: 317–319

    Article  CAS  Google Scholar 

  77. Warren JL et al. (1999) Use of Medicare hospital and physician data to assess breast cancer incidence. Med Care 37: 445–456

    Article  CAS  Google Scholar 

  78. Freeman JL et al. (2000) An approach to identifying incident breast cancer cases using Medicare claims data. J Clin Epidemiol 53: 605–614

    Article  CAS  Google Scholar 

  79. Gold MR et al. (Eds) (1996) Cost-effectiveness in Health and Medicine. New York: Oxford University Press

    Google Scholar 

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Authors and Affiliations

  1. Division of Cancer Control and Population Sciences, KR Yabroff and JL Warren are Epidemiologists at, and ML Brown is Chief of, the Health Services and Economics Branch, Applied Research Program, National Cancer Institute, Bethesda, MD, USA.,

    K Robin Yabroff, Joan L Warren & Martin L Brown

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  1. K Robin Yabroff
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Correspondence to K Robin Yabroff.

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Study characteristics of heath care-related costs of cancer in the US (DOC 362 kb)

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Yabroff, K., Warren, J. & Brown, M. Costs of cancer care in the USA: a descriptive review. Nat Rev Clin Oncol 4, 643–656 (2007). https://doi.org/10.1038/ncponc0978

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