ASCO: Study examines Medicare expenditures for cancer treatments

June 3, 2019

Cancer is the second most costly medical condition in the United States behind heart disease, and a study presented at the American Society of Clinical Oncology (ASCO) sought to better understand Medicare costs.

Cancer is the second most costly medical condition in the United States behind heart disease, and a study presented at the American Society of Clinical Oncology (ASCO) sought to understand Medicare costs better and create a foundation for future analysis.

The poster paper, titled “National cancer expenditure analysis in the United States Medicare population, 2013”  by Emily S. Ruiz, MD, MPH (et al.) from Brigham and Women’s Hospital and Harvard Medical School examined the national cancer expenditures by Medicare recipients during 2013. The paper states there is “no comprehensive analysis evaluating total cancer costs by cancer and treatment modality.”

Of the $87.5 billion spent on cancer treatment in 2012, about 33 percent ($28.7 billion) was used by Medicare patients. Cancer treatment represented 5 percent of total Medicare spending in 2013. Medicare expenses, the researchers add, contributed to budget deficits totaling 2.9 percent of the gross domestic product (GDP) in 2017. That total is expected to rise to 9.8 percent of GDP in 2047.

“It is important to understand how resources are currently allocated, especially for the most costly diseases, before recommending reform delivery methods,” the researchers state. This paper sought to offer benchmark data on the direct cost of cancer treatment to Medicare fee-for-service recipients during this period.

While cancer was attributed to 600,000 deaths in 2013, lung, breast, and prostate cancers ranked as the most costly and the most prevalent. Multiple myeloma, esophageal/stomach, and pancreatic cancers were the most expensive per patient.

Relating to the cost of care, Medicare recipients were responsible for about 12 percent of total costs of treatment, “which can place an enormous financial burden on patients, especially those requiring more expensive treatments.”

Drug spending accounted for about one-third of spending, the study says.

Breakdown of Medicare expenditures on cancer treatment:

  • Professional fees: $12 billion
    -Office-based systemic therapy: $4.2 billion
    -Surgery: $1.9 billion
    -Radiation: $2.2 billion
    -Other: $3.7 billion

  • Inpatient facilities: $6.5 billion

  • Outpatient facilities: $1.1 billion

  • Oral chemotherapy: $4.7 billion for oral chemotherapy

  • Hospital-based chemotherapy: $4.3 billion

  • Out-of-pocket expenses: $2.8 billion

Treatment costs by cancer type:

  • Lung/thoracic cancer: $2.9 billion

  • Breast: $2.5 billion

  • Prostate: $2.3 billion

  • Secondary malignant neoplasms: $2.2 billion
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