Cancer outcomes continue to improve, and spending has grown slower than several other diseases

Compared to similar countries, the United States has higher rates of mortality for most of the leading causes of death, and generally performs worse on a variety of quality indicators. Cancer, however, is one area where the U.S. stands out with better outcomes across a range of measures.  The U.S. has lower-than-average mortality rates and disease burden caused by cancer, and also has somewhat higher-than-average survival rates for certain cancers.  With the current focus on cancer treatment inspired by President Obama’s initiative, led by Vice President Biden, “moonshot” to find a cure for cancer, we take a look at recent trends in cancer cost and outcomes in the U.S. and how these outcomes compare to other countries.

Cancer Outcomes in the U.S. and Similar Countries

The U.S. mortality rate for cancer is among the lowest of twelve comparable OECD countries (those with above median GDP and GDP per capita in at least one of the past 10 years). Of these countries, only Switzerland, Japan, and Sweden have lower mortality rates from cancer than the U.S.  In the U.S., the age-adjusted mortality rate due to cancer was 203 deaths per 100,000 people, compared to an average of 212 deaths in other comparably wealthy countries.

Cancer is one area where the U.S. stands out, with better outcomes across a range of measures Click To Tweet

Though often talked about collectively, the numerous types of cancer are distinct diseases, each with varying outcomes. Five-year survival rates for breast cancer and colorectal cancer in the U.S. are slightly higher than in comparable countries, but the rate for cervical cancer is slightly lower in the U.S.  The use of five-year survival rates in cross-national comparisons has been debated recently, as survival rates may be more heavily influenced by the time of diagnosis than the actual longevity of the patient. One study also found that while the U.S. outperforms comparable countries on survival rates for breast and colorectal cancer, this is not the case for all cancers, including lung cancer.

Another way to assess cancer outcomes is to look at disease burden, which encompasses both premature death and years lived with poor health or disability. Using a measure called Disability Adjusted Life Years (DALYs), the Institute for Health Metrics and Evaluation finds that cancer is the third-leading cause of disease burden in the U.S., following circulatory diseases and mental health conditions. Over time, the diseases categories that cause the most disease burden in the U.S. have changed.  In 1990, cancers were the second-leading cause of DALYs, but the rate has since declined significantly.

Though unknown to what extent, some of the difference between the U.S. and other countries’ cancer outcomes could to be due to non-medical determinants of health, including behavioral factors like tobacco use. Data from the World Lung Foundation and The American Cancer Society show that fewer cigarettes are smoked per capita per year in the U.S. than in most comparable countries (though data from OECD show that total tobacco consumption, as measured in grams per capita, in the U.S. is similar to comparable countries, on average). Even so, the Institute for Health Metrics and Evaluation estimates that the U.S. has a higher-than-average disease burden from lung cancer.

The Cost of Treating Cancer in the U.S.

Although cancer is the second-leading cause of death and the third-leading cause of disease burden in the U.S., it represents just below 7% of total medical services spending on disease treatment, according to recent estimates by the Bureau of Economic Analysis (BEA). In 2012, Americans spent $124 billion on the treatment of cancers and tumors, compared to $243 billion to treat circulatory diseases and $188 billion on the treatment of musculoskeletal conditions. Another large area of health spending is for “ill-defined” conditions ($247 billion), a broad category that encompasses general check-ups and preventive screenings, some of which could help prevent or improve early detection of cancer. The BEA estimates are limited in that they do not include spending on nursing homes, and internationally comparable data on disease-based expenditures are also unavailable.

On a per capita basis, the U.S. spent about $394 in 2012 to treat cancer, up from $219 in 2000, according to the BEA.  Overall, cancer spending grew at a somewhat slower pace than spending on other disease treatment during this period.  However, the cost to treat each case of cancer grew somewhat faster than the average treatment cost for other diseases (4.6% vs. 4.4% from 2000 – 2012).  As is the case for medical services spending generally over this period, growth in spending on cancer care was primarily driven by increases in the cost of treating cancer (such as higher prices and greater service intensity), and to a lesser extent by increases in the number of people being treated for cancer.

Most of the increase in cancer spending has been driven by higher treatment prices Click To Tweet

For those battling cancer, the cost of treatment can be very high. People with a current or prior diagnosis of cancer have significantly higher spending on average than people without a diagnosis. Our analysis of data from the Medical Expenditure Panel Survey (MEPS) finds that average health spending (including insurer claims and out-of-pocket costs) for people who had ever had a cancer diagnosis was $11,516 in 2013, compared to an average of $4,411 who had never been diagnosed with cancer. People with a current or prior diagnosis of cancer face higher average out-of-pocket costs than people without a diagnosis. Average out-of-pocket spending for people who had ever had a cancer diagnosis was $1,419 in 2013, compared to an average of $635 who had never been diagnosed with cancer.

People currently undergoing cancer treatment may be affected by the high costs of new specialty drugs. Cancer medications were among the top 3 in spending for specialty therapy drugs in 2014, according to a recent report by the pharmaceutical benefit manager, Express Scripts. Spending on cancer medications neared $42 per-member-per-year in 2014, exceeded only by spending on specialty drugs to treat multiple sclerosis and inflammatory conditions ($52 and $80, respectively). In a related study looking only at those patients with ultra-high drug costs (over $100,000 in a single year), Express Scripts found that 32% of these patients were taking cancer medication. The report notes that most of the costs for patients with drug total costs over $100,000 were covered by insurance. Still, out-of-pocket drug expenses for this group (including those with non-cancer diagnoses) neared $2,800 on medication alone in 2014, according to the report.

As the cost of treating cancer in the U.S. has risen since 2000, most of the increase in spending has been driven by higher prices and greater service intensity. The introduction of new specialty medications may offer hope for patients and contribute to better outcomes, while also raising affordability concerns.