Source: www.medscape.com
Author: Nick Mulcahy

Because of the growth in the number of older Americans, there will be 18.1 million cancer survivors by 2020 in the United States — 4.3 million more than in 2010. And the associated costs of cancer care will be $157.77 billion — $33.20 billion more than in 2010, according to a new study published online January 12 in the Journal of the National Cancer Institute.

However, these long-term cost projections assume that the incidence, survival, and annual costs remain the same, note the study authors, led by Angela Mariotto, PhD, from the National Cancer Institute.

Dr. Mariotto and her colleagues also crunched the numbers in the event of an annual increase in costs.

They estimate that the cost of care might increase annually by 2% in the initial and last-year-of-life phases of care. If such increases happen, then the total cost in 2020 is projected to be $173 billion, a 39% increase from 2010.

These are conservative numbers, even with the 2% increase in annual costs, said a healthcare policy expert not involved in the study.

The projected 2% annual cost increase should be considered a “lower bound or minimum estimate,” Gary Lyman, MD, MPH, told Medscape Medical News. He is a senior fellow at the Duke Center for Clinical Health Policy Research in Durham, North Carolina. “The true increase in the cost of cancer to patients, families, and society is likely to be considerably greater over this period.”

The study’s scenarios seem unlikely because of cancer trends, explained Dr. Lyman, who is also a medical oncologist and professor of medicine at the Duke University School of Medicine.

“Cancer incidence and survival rates have increased, as have the costs of cancer services such as drugs, hospitalizations, and home care,” he said. One measure that is not increasing in the world of cancer is mortality rates, which have fallen “significantly,” said Dr. Lyman.

The authors say that they took cancer trends into account in their analysis. “Projections of current trends in incidence (declining) and survival (increasing) had small effects on 2020 estimates,” write Dr. Mariotto and colleagues.

They also say that their estimates of the national cost of cancer care for 2010 are “higher than reported elsewhere” because of the use of “the most recent” data for a variety of factors.

Exactly how much the total cost of care will increase in the United States in 2020 is, of course, not clear. However, what all parties agree on is that cost will increase, if only because aging baby boomers will lead to an increase in the number of older Americans. As the study authors point out, cancer incidence is highest in the elderly. The US Bureau of Census projects that the population 65 years and older will increase from 40 million in 2009 to 70 million in 2030, report the study authors.

Wild Card: Targeted Therapies
In addition to their projections based on constant incidence, survival, and cost, and on a 2% annual cost increase, Dr. Mariotto and her colleagues report another cost projection. They estimate a 5% increase in the annual cost of care in the initial and last phases of life, resulting from an expected increase in the use of targeted cancer therapies. This would yield a projected $207 billion cost in 2020 — a 66% increase from 2010.

The study authors then make a hopeful comment: “Trends in costs associated with the use of targeted chemotherapies might be mitigated somewhat through the use of genomic-based prognostic markers.”

Dr. Lyman has the same hope. “Enhanced efforts to identify and validate biomarkers for treatment benefit or resistance . . . offer the potential to constrain rapid increases in healthcare costs as a result of these agents,” he said.

What else can be done? The study authors did not have much to say; the remediation of costs was beyond the scope of their paper. Dr. Lyman, however, puts a great deal of stock in the concept of comparative effectiveness.

Reducing cancer costs is not going to happen in the short term, he warned.

Policies based on comparative effectiveness can help “slow the growth” of American cancer expenditures, said Dr. Lyman, who is, among his other positions, the director of the Comparative Effectiveness and Outcomes Research program at Duke.

The availability of cancer treatments should be linked to their demonstrated effectiveness, and safety should be based on clinical trials, he said. “If the results of such comparative-effectiveness research could be accepted for regulating the availability and utilization of cancer treatments, it is likely the rise in healthcare costs could be at least slowed.”

In the United States, the best bet for the future is in prevention and early detection, said Dr. Lyman, calling them the “only reasonable long-term solution.”

By increasing prevention and early detection efforts, the United States could “significantly decrease the incidence and eventually the prevalence of cancer in the population,” he said. “The majority of cancers in the adult population are either preventable or diagnosable at an early stage of disease, when treatment, if needed, is associated with much less toxicity and cost.”

Source: J Natl Cancer Inst. 2011;103:117-128.