New Study Shows Why Cancer Cost Planning Needs to Start Accounting for People Under 65

Reprinted with permission from the Journal of the National Comprehensive Cancer Network. Media Contact: Rachel Darwin, 267-622-6624, darwin@nccn.org

A study published in JNCCN estimates costs for people age 18 and up, ranks the price tags of the top four cancer types, and highlights potential cost-saving benefits of prevention and screening.

A new study published in JNCCN – Journal of the National Comprehensive Cancer Network finds that cancer care costs in the United States are higher for people under age 65, and the costs increase with disease stage. Despite the fact that nearly half of new cancer diagnoses occur in people younger than 65, most cost projections are based on SEER-Medicare data, which is typically limited to populations aged 65 or older. This new research compares medical care cost estimates for individuals age 18 and above, providing important evidence about the cost of cancer care across the age spectrum.

"We felt it was important to improve our understanding of cancer costs in the United States for adults of all ages," said lead author Matthew P. Banegas, PhD, a health services researcher with the Kaiser Permanente Center for Health Research in Portland, Oregon. "Our hope is that the cost estimates in our study will be a valuable resource not only for future research—including inputs for cost- and comparative-effectiveness analyses—but also for oncology program and policy planning within health systems. Any effort to bend the cancer care cost curve must be informed by reliable data from multiple health settings and populations. Our study represents an important step in that direction, and we hope that future studies will continue to help us understand overall costs and cost drivers."

The study examined medical care costs for the four most common types of cancer in the United States: breast, colorectal, lung, and prostate cancer. The researchers found average 1-year costs for lung cancer ranged from $50,700(stage I) to $97,400 (stage IV) among patients younger than 65, and from $44,000 (stage I) to $71,200 (stage IV) among patients aged 65 and older (reported in 2015 dollars and adjusted for inflation). Five-year costs followed the same pattern. In general, it was more expensive to treat lung and breast cancers than colorectal or prostate cancers, but care got more expensive in later stages for all types.

Dr. Banegas offered a word of caution that these numbers could be on the low side: "Given that cancer care costs have continued to rise since the end of our study period (2008), the costs we report serve as conservative estimates of what we expect to see for the foreseeable future."

The researchers looked at 45,522 adults diagnosed with cancer between January 1, 1988 and December 31, 2007 with at least 30 days of continuous health plan eligibility during the study period (January 1, 2000 through December 31, 2008). All were enrolled in one of the following four health plans: Henry Ford Health System (Detroit, MI); Kaiser Permanente Colorado (Denver, CO); Kaiser Permanente Northwest (Portland, OR); and Kaiser Permanente Washington (formerly Group Health Cooperative, Seattle, WA). These plans provide both private and public health insurance coverage, including Medicare Advantage and Medicaid risk contracts. Patients were matched with a control population without any history of cancer. Medical care costs were estimated using the Standardized Relative Resource Cost Algorithm.1 The participants were followed until date of death, disenrollment from their health plan, or the end of the observation.

In addition to expanding on the age group, the researchers extended findings from similar studies based on Medical Expenditure Panel Survey (MEPS) data, adding key clinical information such as stage at diagnosis and date of diagnosis.2Their hope is to provide a unique tool for comparing monthly phase-of-care, 1-year, and 5-year cost estimates based on age at diagnosis, stage at diagnosis, and total versus net cost.

The findings confirm prior research demonstrating that screening and early detection is cost effective compared with treating cancer after it becomes symptomatic.

"This study emphasizes some important lessons about cancer care and prevention," said Dawn Provenzale, MD, MS, Chair of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Colorectal Cancer Screening. "Namely, treatment for early stage cancer is less costly than treatment for later stage disease, underscoring the importance of screening in order to detect cancer at an earlier stage. Identifying and treating cancer at an early stage can save money and lives in the long term. The authors should be congratulated for providing new information on cancer care costs that emphasizes the importance of prevention and early detection."

For a look at the full findings, including data tables comparing costs by cancer type, stage, age group, and other demographics, visit JNCCN.org. Complimentary access to the study "Medical Care Costs Associated with Cancer in Integrated Delivery Systems" is available until June 10, 2018.

About JNCCN—Journal of the National Comprehensive Cancer Network

More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about best clinical practices, health services research, and translational medicine. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside Press. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit http://www.nccn.org/jnccn/subscribe.asp. Follow JNCCN on Twitter @JNCCN.

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers.

The NCCN Member Institutions are: Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women's Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Comprehensive Cancer Center, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Rogel Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.

Clinicians, visit NCCN.org. Patients and caregivers, visit NCCN.org/patients. Media, visit NCCN.org/news. Follow NCCN on Twitter @NCCNnews and Facebook @National.Comprehensive.Cancer.Network.

1 O'Keeffe-Rosetti MC, Hornbrook MC, Fishman PA, et al. A standardized relative resource cost model for medical care: application to cancer control programs. J Natl Cancer Inst Monogr 2013;2013:106–116.

2 Zheng Z, Yabroff KR, Guy GP Jr, et al. Annual medical expenditure and productivity loss among colorectal, female breast, and prostate cancer survivors in the United States. J Natl Cancer Inst 2016;108:djv382.