LONG BEACH, Calif--Neoplasms account for more than 5% of the $675 billion in direct annual US health-care expenditures, Thomas C. Tucker, MPH, said at the 1995 Quality of Life Symposium, sponsored by St. Mary Medical Hospital. This figure, derived from a 1990 National Center for Health Statistics Survey, does not include indirect costs, such as loss of wages, associated with morbidity and mortality.
When the less malignant neoplasms (basal and squamous cell skin cancers and in situ carcinoma of the cervix) are excluded, the cost burden for cancer is about 4% of the direct expenditures.
Cancer accounts for an even larger proportion of US health-care expenditures when both direct and indirect costs are combined. "It is not a small proportion of the burden," said Mr. Tucker, associate professor of health services management and associate director for Cancer Control, University of Kentucky Markey Cancer Center, Lexington.
The cancer care costs break down to about 65% for hospital care, 24% for physician services, and 4% for nursing home care, with drugs and other services making up the remaining 6% or 7%. He noted that the 65% for hospital care is much higher than the 40% hospital expenditure for all diseases. Nursing home costs and drug expenditures for cancer patients are also higher, but the physician expenditures are similar to those for the total of all diseases.
Mr. Tucker described a 1989 study based on Medicare's Continuous Medical History sample file (about 5% of all Medicare cases), which includes all the expenditures related to care of patients in the file who ultimately died of their disease. This study sorted out direct expenditures into three parts: the first 3 months of care, the monthly cost of continuing care, and the terminal phase of care, ie, the last 6 months of life.
Initial costs for patients with the same cancer varied considerably, he said, depending on the stage at diagnosis and initial treatment. Surgery, for example, has a major impact. Continuing cost also varied, since it was determined by multiplying the monthly expense by the number of months the patient lived. The cost of the last 6 months of care did not vary much for patients with the same disease.
Using the Medicare data, the US expenditure on the treatment of breast cancer in 1990 was estimated at $6.5 billion, followed by colon cancer, lung cancer, prostate cancer, and bladder cancer. More than two thirds of the cost are accounted for by these five tumors, Mr. Tucker said, and, in fact, well over half are accounted for by only the first four tumors.