The cost of care for patients with the 15 most prevalent types of cancer came to just over $156 billion in 2018, according to new findings.
While healthcare costs overall have continued to rise over the years, the trend is especially pronounced for cancer care. The price tags for oncology drugs, in particular, have skyrocketed, with some costing more than $1 million per patient per year.
Despite these trends, estimates of resources and spending devoted to cancer care in the United States for privately insured patients remain limited.
To better understand the most common and costly services, Nicholas Zaorsky, MD, assistant professor, Departments of Radiation Oncology and Public Health Sciences at the Penn State College of Medicine, and researcher at Penn State Cancer Institute, Hershey, and colleagues, analyzed data from MarketScan, a large private insurance database.
With Medicaid and private insurance covering an increasing portion of cancer costs, “our study helps to highlight the areas that may be most likely to be associated with this increase in spending,” the authors write.
The results were published online October 6 in JAMA Network Open.
The analysis, which included data from 402,115 privately insured patients under age 65 with the 15 most common cancer types, found the total estimated cost of cancer care in 2018 came to $156.2 billion.
When Zaorsky and colleagues analyzed the contributions of different cancer types and services, they found 38.4 million documented procedure codes for the 15 cancers, totaling $10.8 billion. Patients with breast, colorectal, and prostate cancer had the greatest number of services performed, at 10.9 million, 3.9 million, and 3.6 million, respectively.
Breast cancer was also the most common (n = 124,543) and expensive type of cancer, costing a total of $3.4 billion (31.5%). Lung and colorectal cancers were the second most expensive cancers to treat at $1.1 billion each, followed by lymphoma at $1.02 billion and prostate cancer at $832 million.
Of the seven categories of services the authors reviewed, pathology and laboratory tests were the most common, representing just over 30% of the 38.4 million services (11.7 million), followed by medical services at 16.4% (6.3 million), and medical supplies and nonphysician services at just under 16% (6.1 million).
The largest expenditures were for medical supplies, including anticancer drugs and nonphysician services, costing $4 billion (37% of $10.8 billion), followed by radiology at $2.1 billion (19.4%) and surgery at $1.8 billion (16.7%).
Studies have shown that these high costs often cannot be justified with respect to clinical benefit, and the authors note that “further research is needed to explore the extent to which these costs reflect unnecessary or low-value care.”
Arjun Gupta, MD, who was not involved with the research, agreed, noting that two of the top 10 costliest medications — pegfilgrastim and denosumab — are for supportive care, and eight of the top 10 most used drugs — including dexamethasone, antiemetics such as ondansetron and palonosetron, and pain/sedation medications such as fentanyl — are also for supportive care.
“Spending on supportive care services can add up and contribute a substantial proportion to overall spending and patients’ out-of-pocket costs,” Gupta, assistant professor of medicine, Division of Hematology, Oncology and Transplantation at the University of Minnesota Medical School, Minneapolis, told Medscape Medical News. “While we cannot assess appropriateness here, we know from other work that some of this use is unnecessary.”
According to Zaorsky and colleagues, the evolving insurance landscape may account for the increasing share of cancer costs paid by private insurance and Medicaid. One reason is the Patient Protection and Affordable Care Act significantly increased Medicaid coverage and removed some of the barriers to obtaining private coverage such as preexisting condition exclusions.
“Second, as private payers tend to pay significantly higher rates for care, and as new high-cost cancer therapies reach the market, private payers inevitably pay much more both overall and relative to other payers,” the authors note. “Third, cancer rates for colorectal cancer and human papillomavirus–related cancers are increasing in some populations of patients younger than 65 years, and thus, private payers and Medicaid will pay relatively more for cancer care.”
Zaorsky has reported receiving start-up funding from Penn State Cancer Institute and Penn State College of Medicine, the National Institutes of Health, and the American Cancer Society. Disclosures for the other authors are listed in the article. Gupta has reported no relevant financial relationships.
JAMA Netw Open. 2021;4:e2127784. Full text