Rising Costs of Cancer Survivorship a Growing Concern

Neil Canavan

November 2013, Vol 4, No 9 - Economics of Cancer Care

Survival is not cheap. In fact, according to the results of a new study, cancer survivors have ongoing annual medical expenditures averaging $17,000 per patient in the first year after diagnosis, or $6400 per patient at least 1 year postdiagnosis (Guy GP Jr, et al. J Clin Oncol. 2013;31:3749-3757). Considered in aggregate, this comes to a nationwide expense of approximately $41 billion for patients younger than age 64 years—and for older patients, the figures are even higher.

“Our study demonstrates that cancer survivorship is associated with a considerable economic impact on society,” lead investigator Gery P. Guy, Jr, PhD, MPH, of the Centers for Disease Control and Prevention’s Division of Cancer Prevention and Control, told Value-Based Cancer Care. “Although the economic burden is greatest shortly after diagnosis, we also found that the burden remains high years after a cancer diagnosis.”

The Cost of Surviving Cancer
Getting a handle on survivorship costs is of rapidly increasing importance. As of 2012, an estimated 13.7 million Americans are now cancer survivors, and this number is expected to quickly rise as novel treatments, combined with early detection strategies, greatly enhance the life expectancy of the average patient with cancer.
Gains in survival time, if not outright cures, are inevitably associated with a variety of long-term downsides, including cardiotoxicity, sexual dysfunction, incontinence, ongoing pain, fatigue, and so on. Furthermore, survivorship is associated with an ongoing loss of productivity, at work or in the home. Until now, there have been no coordinated analyses of both costs.

“This is the first study to quantify both medical expenditures and lost productivity as a result of cancer survivorship in adults of all ages at the national level,” explained Dr Guy. “We used the same data source for all of our estimates, allowing for important comparisons between groups (older and younger patients) and by type of burden.”

The analysis used data from the Medical Expenditure Panel Survey for the period from 2008 through 2010, comparing responses from 4960 patients with cancer versus more than 60,000 individuals without cancer.

Direct medical costs were assessed by source of payment and service type. Indirect costs, namely loss of productivity, were estimated by the consideration of employment disability, missed workdays, and lost household productivity.

Aggregate Expenditures in the Billions
The results of the analysis show that recently diagnosed (ie, first-year) cancer survivors (ages 18-64 years) have annual medical costs averaging $17,170 compared with $6485 for longer-term survivors, and $3611 for those who have never had cancer.

For patients aged >64 years, first-year survivors are paying an average of $23,441 annually compared with $12,357 for long-term survivors, and $8724 for the control group. For the older patients with cancer, extrapolated aggregate costs exceed $48 billion nationwide.

For the younger patients with cancer cohort, the most common source of payment was private health insurance, whereas the largest payer for older patients was Medicare.

Regarding the general services provided, ambulatory care accounted for the greatest expenditure in the younger cohort, whereas costs for inpatient care accounted for the greater share overall for older patients. Considering the loss of productivity, younger first-year survivors (ages 18-64 years) took a hit to their paychecks on average of $4694 annually compared with $3593 for longer-term survivors, and $2040 for those without cancer.

For individuals aged >64 years, the average loss of productivity was $6133 for newly diagnosed patients, and $5295 for previously diagnosed patients. In aggregate, lost productivity for both age-groups combined is estimated to be in excess of $26 billion.

The largest share of aggregate loss in productivity for both age-groups came from employment disability ($19 billion), followed by missed workdays ($4 billion), and lost household productivity ($3 billion).

Underestimated Costs?
Dr Guy is quick to point out that these estimates are still on the low side. For instance, the costs for patients who die within 1 year of a cancer diagnosis were not included, nor were the more nebulous expenses, such as those incurred by the caregivers of cancer survivors.

“We likely underestimated the burden of cancer survivorship among adults by not including caregivers’ productivity losses and the intangible costs associated with pain and suffering….[However], studies are currently under way to examine the additional costs associated with cancer survivorship.”

In the meantime, is there anything to be done, beyond cancer prevention, to reign in cancer survival costs?

Dr Guy focuses on productivity. “Efforts to reduce the health and economic burden caused by cancer are important given the burden of cancer survivorship. Cancer survivors may face challenges with returning to, or functioning in work after a cancer diagnosis,” he noted. “Additional research is needed to identify appropriate educational and work modifications to aid in the transition and retention of cancer survivors in the workplace. Such interventions could help maximize employment opportunities and workplace productivity. In addition, ensuring access to lifelong risk-based follow-up care and adherence to survivorship care plans are important components in improving the quality of life among cancer survivors.”