Highest Cancer Care Cost Burden Happens at 2 Time Points in Medicare, Report Says

A report out this week on the economic burden of cancer found that patients with Medicare coverage saw the highest costs in the beginning stages of the disease and in the last phase.

Overall, in 2019, the national patient economic burden of cancer care was $21.09 billion, comprising patient out-of-pocket (OOP) costs of $16.22 billion and patient time costs of $4.87 billion.

The annual report, from the American Cancer Society, the National Cancer Institute, the CDC, and the North American Association of Central Cancer Registries, details US cancer trends.

Two linked datasets were used: Surveillance, Epidemiology, and End Results (SEER)-Medicare and the Medical Expenditure Panel Survey (MEPS). The 2000-2013 SEER Medicare data were used to estimate net patient OOP costs among adults 65 years and older for the initial, continuing, and end-of-life phases of care for all cancer sites combined and separately for the 21 most common cancer sites.

The 2008-2017 MEPS data were used to calculate OOP costs and time costs associated with cancer among adults aged 18 to 64 years and 65 years and older.

Among adults 65 years and older who had Medicare coverage, average annualized net OOP costs for medical services and prescription drugs, across all cancer sites, were highest in the first 12 months following diagnosis ($2200 and $243, respectively). During the end-of-life phase, defined as the 12 months before death, costs were $3823 for medical services and $448 for prescription drugs.

During the continuing phase (in between the initial and end-of-life phases), costs were $466 and $127, respectively.

Across all cancer sites, average annualized net patient OOP costs for medical services in the initial and end-of-life phases of care were lowest for patients whose original diagnosis was for localized disease compared with more advanced stage disease.

Time costs are the value of time patients spend traveling to and from health care, waiting for care, and receiving cancer care. Net annual time costs were $304.3 (95% CI, $257.9 -$350.9) for adults aged 18 to 64 years and $279.1 (95% CI, $215.1-$343.3) for adults 65 years and older.

Patients with newly diagnosed cancer had higher time costs.

Analyses of the differences in patient economic burden by cancer type found substantial variation in patient OOP costs, reflecting differences in treatment intensity and duration as well as survival. In 2019, national OOP costs were highest for breast ($3.14 billion), prostate ($2.26 billion), colorectal ($1.46 billion), and lung ($1.35 billion) cancers, reflecting the higher prevalence of these cancers.

The report was published in JNCI: The Journal of the National Cancer Institute. The total overall costs of cancer care and lost productivity are much larger than just patient-related costs alone, the report noted.