Abstract
Currently, there are limited published data regarding resource use and spending on cancer care in the US. To characterize the most frequent medical services provided and the associated spending for privately insured patients with cancer in the US. This cohort study used data from the MarketScan database for the calendar year 2018 from a sample of 27.1 million privately insured individuals, including patients with a diagnosis of the 15 most prevalent cancers, predominantly from large insurers and self-insured employers. Overall societal health care spending was estimated for each cancer type by multiplying the mean total spending per patient (estimated from MarketScan) by the number of privately insured patients living with that cancer in 2018, as reported by the National Cancer Institute's Surveillance, Epidemiology, and End Results program. Analyses were performed from February 1, 2018, to July 8, 2021. Evaluation and management as prescribed by treating care team. Current Procedural Terminology and Healthcare Common Procedure Coding System codes based on cancer diagnosis code. The estimated cost of cancer care in 2018 for 402 115 patients with the 15 most prevalent cancer types was approximately $156.2 billion for privately insured adults younger than 65 years in the US. There were a total of 38.4 million documented procedure codes for 15 cancers in the MarketScan database, totaling $10.8 billion. Patients with breast cancer contributed the greatest total number of services (10.9 million [28.4%]), followed by those with colorectal cancer (3.9 million [10.2%]) and prostate cancer (3.6 million [9.4%]). Pathology and laboratory tests contributed the highest number of services performed (11.7 million [30.5%]), followed by medical services (6.3 million [16.4%]) and medical supplies and nonphysician services (6.1 million [15.9%]). The costliest cancers were those of the breast ($3.4 billion [31.5%]), followed by lung ($1.1 billion [10.2%]) and colorectum ($1.1 billion [10.2%]). Medical supplies and nonphysician services contributed the highest total spent ($4.0 billion [37.0%]), followed by radiology ($2.1 billion [19.4%]) and surgery ($1.8 billion [16.7%]). This analysis suggests that patients with breast, colorectal, and prostate cancers had the greatest number of services performed, particularly for pathology and laboratory tests, whereas patients with breast, lung, lymphoma, and colorectal cancer incurred the greatest costs, particularly for medical supplies and nonphysician services. The cost of cancer care in 2018 for the 15 most prevalent cancer types was estimated to be approximately $156.2 billion for privately insured adults younger than 65 years in the US.
Highlights
Cancer care spending in the US for those older than 65 years with Medicare was estimated to be $125 billion in 2010; this amount is estimated to increase to $158 billion in 2020.1,2 The largest increases are seen in the continuing phase of care for prostate cancer (42%) and female breast cancer (32%)
Pathology and laboratory tests contributed the highest number of services performed (11.7 million [30.5%]), followed by medical services (6.3 million [16.4%]) and medical supplies and nonphysician services (6.1 million [15.9%])
Medical supplies and nonphysician services contributed the highest total spent ($4.0 billion [37.0%]), followed by radiology ($2.1 billion [19.4%]) and surgery ($1.8 billion [16.7%]). This analysis suggests that patients with breast, colorectal, and prostate cancers had the greatest number of services performed, for pathology and laboratory tests, whereas patients with breast, lung, lymphoma, and colorectal cancer incurred the greatest costs, for medical supplies and nonphysician services
Summary
Cancer care spending in the US for those older than 65 years with Medicare was estimated to be $125 billion in 2010; this amount is estimated to increase to $158 billion in 2020.1,2 The largest increases are seen in the continuing phase of care for prostate cancer (42%) and female breast cancer (32%). National spending for cancer care is substantial and expected to increase because of population changes alone. The direct costs of cancer care include diagnostic tests, hospital and physician fees, and the cost of drug therapy. In the European Union, cancers of the lung, breast, prostate, and colorectum have been shown to contribute to the plurality of cost, with most costs stemming from inpatient care.[4] In the US, many patients have private insurance or are diagnosed before 65 years of age. There are limited data regarding population estimates of resources and spending on cancer care in the US for patients with private insurance
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