Peterson-Kaiser Health System Tracker What are recent trends in cancer spending and outcomes?
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Transcript of Peterson-Kaiser Health System Tracker What are recent trends in cancer spending and outcomes?
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Peterson-Kaiser Health System Tracker
What are recent trends in cancer spending and outcomes?
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Peterson-Kaiser Health System Tracker
Endocrine, nutritional and metabolic diseases
Mental and behavioral disorders
Diseases of the nervous system
External causes of mortality
Diseases of the respiratory system
Cancers and tumors (Neoplasms)
Diseases of the circulatory system
0 50 100 150 200 250 300
34
40
48
60
82
203
265
23
29
29
43
63
212
243
Comparable Country Average United States
Source: Kaiser Family Foundation analysis of 2013 OECD data: "OECD Health Data: Health status: Health status indicators", OECD Health Statistics (database). doi: 10.1787/data-00540-en (Accessed on January 22, 2016). Note: Comparable countries are defined as those with above median GDP and above median GDP per capita in at least on of the past ten years.
Unlike the other leading causes of death, cancer mortality rates are lower in the U.S. than in comparable countriesAge-adjusted major causes of mortality per 100,000 population, in years, 2010
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Peterson-Kaiser Health System Tracker
Switzerland
Japan
Sweden
United States
Australia
Austria
Comparable Country Average
Germany
Canada
France
Belgium
United Kingdom
Netherlands
0 50 100 150 200 250 300
188
191
196
203
206
210
212
212
215
216
224
231
247
Source: Kaiser Family Foundation analysis of 2013 OECD data: "OECD Health Data: Health status: Health status indicators", OECD Health Statistics (database). doi: 10.1787/data-00540-en (Accessed on January 22, 2016). Note: Comparable countries are defined as those with above median GDP and above median GDP per capita in at least on of the past ten years.
Compared to similar countries, the U.S. has a relatively low mortality rate for cancers
Age-adjusted neoplasm mortality rate per 100,000 population, in years, 2010
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Peterson-Kaiser Health System Tracker
Source: Kaiser Family Foundation analysis of 2013 OECD data: "OECD Health Data: Health status: Health status indicators", OECD Health Statistics (database). doi: 10.1787/data-00540-en (Accessed on January 22, 2016). Notes: Comparable countries are defined as those with above median GDP and above median GDP per capita in at least on of the past ten years. Break in series in 1987 and 1997 for Switzerland; in 1995 for Switzerland; in 1996 for Netherlands; in 1998 for Australia, Belgium, and Germany; in 1999 for United States; in 2000 for Canada and France; and in 2001 in the United Kingdom. All breaks in series coincide with changes in ICD coding.
The mortality rate for cancers has been falling in the U.S. and across comparable countries
Age-adjusted neoplasms mortality rate per 100,000 population
0
50
100
150
200
250
300
242
203
262
212Comparable country average
United States
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Peterson-Kaiser Health System Tracker
Breast Cancer Colorectal Cancer Cervical Cancer0
5
10
15
20
25
30
24.9
18
2.5
27.1
22.8
2.3
United States Comparable Country Average
Source: Kaiser Family Foundation analysis of 2013 OECD data: "OECD Health Data: Health status: Health status indicators", OECD Health Statistics (database). doi: 10.1787/data-00540-en (Accessed on January 22, 2016). Notes: Comparable countries are defined as those with above median GDP and above median GDP per capita in at least on of the past ten years. Data for breast and cervical cancers are for females.
Mortality rates for breast and colorectal cancer in the U.S. are lower than in comparable countriesAge-standardized mortality rate per 100,000 population for breast, colorectal, and cervical cancer, in years, (2010)
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Peterson-Kaiser Health System Tracker
Breast Cancer Colorectal Cancer Cervical Cancer0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
85.4%
61.4%
69.6%
90.7%
66.1%69.3%
1990-1992 2005-2011
Source: Surveillance, Epidemiology, and End Results Program (SEER) http://seer.cancer.gov/csr/1975_2012/browse_csr.php?sectionSEL=5&pageSEL=sect_05_table.08.html (Accessed on January 23, 2016). Notes: SEER 9 areas (San Francisco, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, Atlanta). Based on follow-up of patients into 2012.
Five-year survival for breast and colorectal cancers are increasingPercentage of age-adjusted five-year relative survival for breast, colorectal, and cervical cancer, all ages, in years 1990-1992 and 2005-2011
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Peterson-Kaiser Health System Tracker
Breast Cancer Colorectal Cancer Cervical Cancer0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
88.9%
64.2% 61.8%
85.4%
62.9%66.1%
United States Comparable Country Average
Source: Kaiser Family Foundation analysis of 2013 OECD data: "OECD Health Data: Health status: Health status indicators", OECD Health Statistics (database). doi: 10.1787/data-00592-en (Accessed on January 22, 2016). Notes: Comparable countries are defined as those with above median GDP and above median GDP per capita in at least on of the past ten years. Data for breast and cervical cancers are for females.
Five-year survival rates for certain cancers are slightly higher in the U.S. than in comparable countriesPercentage of age-adjusted five-year relative survival for breast, colorectal, and cervical cancer, ages 15-99, in years 2006-2011
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Peterson-Kaiser Health System Tracker
Source: Institute for Health Metrics and Evaluation. Global Burden of Disease Study Data Downloads, available here: http://ghdx.healthdata.org/global-burden-disease-study-2013-gbd-2013-data-downloads
Cancer and circulatory diseases are the leading causes of premature death in the U.S.
Age standardized years of life lost (YLL) rate per 100,000 population, both sexes, 2013
Endocrine (diabetes)
Digestive
Cirrhosis of the liver
Mental and behavioral disorders
Neonatal
Chronic Respiratory
Nervous System
Injuries
Cancers and tumors (neoplasms)
Circulatory
- 500 1,000 1,500 2,000 2,500 3,000 3,500
151
163
342
441
445
594
627
1,882
2,913
3,207
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Peterson-Kaiser Health System Tracker
Source: Institute for Health Metrics and Evaluation. Global Burden of Disease Study Data Downloads, available here: http://ghdx.healthdata.org/global-burden-disease-study-2013-gbd-2013-data-downloads
Cancer is among the top three leading causes of disease burden in the U.S.
Age standardized disability adjusted life years (DALYs) rate per 100,000 population, both sexes, 2013
Skin diseases
Neonatal
Chronic respiratory
Nervous System
Endocrine (diabetes)
Injuries
Musculoskeletal disorders
Cancers and tumors (Neoplasms)
Mental and behavioral disorders
Circulatory
- 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500
629
672
1,424
1,487
1,773
2,519
2,804
3,133
3,266
3,920
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Peterson-Kaiser Health System Tracker
Source: Institute for Health Metrics and Evaluation. Global Burden of Disease Study Data Downloads, available here: http://ghdx.healthdata.org/global-burden-disease-study-2013-gbd-2013-data-downloads
U.S. disease burden has decreased in past two decades for circulatory, cancer, injuries, and neonatal disorders
Skin diseases
Neonatal*
Chronic respiratory
Nervous System
Endocrine (diabetes)
Injuries*
Musculoskeletal disorders
Cancers and tumors (Neoplasms)*
Mental and behavioral disorders
Circulatory*
- 1,000 2,000 3,000 4,000 5,000 6,000 7,000
629
672
1,424
1,487
1,773
2,519
2,804
3,133
3,266
3,920
634
922
1,460
1,426
1,542
3,519
2,657
3,862
2,948
6,007
1990 2013
Age standardized disability adjusted life years (DALYs) rate per 100,000 population, both sexes, 1990 and 2013
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Peterson-Kaiser Health System Tracker
Source: Institute for Health Metrics and Evaluation. Global Burden of Disease Study Data Downloads, available here: http://ghdx.healthdata.org/global-burden-disease-study-2013-gbd-2013-data-downloads
Disease burden due to cancer is most caused by lung cancer; for both males and females
Brain and nervous system
Esophageal
Liver
Leukemia
Non-Hodgkin lymphoma
Other neoplasms
Pancreatic
Prostate
Colon and rectal
Lung and related
166
171
186
194
203
206
281
457
457
1,251
MALESAge standardized disability adjusted life years (DALYs) rate per 100,000 population, males in the U.S., 2013
FEMALESAge standardized disability adjusted life years (DALYs) rate per 100,000 population, females in the U.S., 2013
Cervical
Brain and nervous system
Leukemia
Non-Hodgkin lymphoma
Other neoplasms
Ovarian
Pancreatic
Colon and rectal
Breast
Lung and related
107
108
124
132
183
224
225
351
694
894
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Peterson-Kaiser Health System TrackerSource: Commission on Cancer, American College of Surgeons and American Cancer Society, National Cancer Data Base
More women are receiving biopsy at the time of mastectomy or lumpectomy
Percentage of women with clinical Stage I-IIb breast cancer who received axillary node dissection or sentinel lymph node biopsy (SLNB) at the time of surgery (lumpectomy or mastectomy), United States, 2004-2011
2004 2005 2006 2007 2008 2009 2010 201185%
86%
87%
88%
89%
90%
91%
92%
93%
94%
95%
88.4%
94.3%
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Peterson-Kaiser Health System Tracker
Source: Kaiser Family Foundation analysis of 2013 OECD data: "OECD Health Data: Health status: Health status indicators", OECD Health Statistics (database). doi: 10.1787/data-00349-en (Accessed on January 22, 2016). Notes: Break in series in 1999 for United States. Break in series coincides with changes in ICD coding.
Recent decline in U.S. mortality rates largely reflects improvement for circulatory diseases
Overall age-adjusted mortality rate per 100,000 population
19801982
19841986
19881990
19921994
19961998
20002002
20042006
20082010
0
200
400
600
800
1000
1200
1400
Other Causes
Endocrine, Nutritional and Metabolic
Mental and Behavioral Disorders
Accidents, Suicides and External Causes
Respiratory Diseases
Cancers and tumors (Neoplasms)
Circulatory Diseases
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Peterson-Kaiser Health System Tracker
Ill-defined conditions; $247
Circulatory, $243
Musculoskeletal, $188
Respiratory, $158
Endocrine; $138Nervous system; $133
Cancers; $124
Injury; $118
Genitourinary; $113
Digestive; $107Mental Illness; $80
Infectious diseases; $67Dermatological; $44
Pregnancy, birth; $39Other; $93
Source: Bureau of Economic Analysis Health Care Satellite Account (Blended Account) and National Health Expenditure Data Note: Spending on dental services, nursing homes, and prescriptions that cannot be allocated to a specific disease not included above. Data last updated January 25, 2016.
Cancer spending accounts for about 7% of disease based health expenditures
Total expenditures in US $ billions by disease category, 2012
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Peterson-Kaiser Health System Tracker
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012$0
$50
$100
$150
$200
$250
$300
$350
$400
$450
$219$241 $257 $268
$290 $301$322 $335 $352
$375 $379 $394 $394
Source: Kaiser Family Foundation analysis of Bureau of Economic Analysis Health Care Satellite Account (Blended Account)Note: Expenditures on nursing home and dental care are not included in health services spending by disease. Data last updated January 25, 2016.
On a per capita basis, the U.S. spends about $394 per year to treat cancer, up from $219 in 2000Per capita expenditures on the treatment of cancers and tumors (neoplasms), US $, 2000 - 2012
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Peterson-Kaiser Health System Tracker
Source: Kaiser Family Foundation analysis of Bureau of Economic Analysis Health Care Satellite Account (Blended Account)Note: Expenditures on nursing home and dental care are not included in health services spending by disease. Data last updated January 25, 2016.
While Cancer is one of the top contributors to disease burden, it is not a leading driver of medical services spending growth from 2000-2012
Contribution to medical services expenditure growth, by disease, 2000-2012
Pregnancy/childbirth
Dermatological
Mental illness
Infectious diseases
Digestive
Injury and poisoning
Genitourinary
Other
Cancer
Respiratory
Nervous system
Endocrine
Circulatory
Musculoskeletal
Ill-defined conditions
0% 2% 4% 6% 8% 10% 12% 14% 16% 18%
1.7%
2.3%
4.1%
4.4%
5.1%
5.3%
5.9%
6.2%
6.3%
6.5%
7.4%
8.5%
8.6%
11.0%
16.6%
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Peterson-Kaiser Health System Tracker
Source: Kaiser Family Foundation analysis of Bureau of Economic Analysis Health Care Satellite Account (Blended Account)Note: Expenditures on nursing home and dental care are not included in health services spending by disease. Data last updated January 25, 2016.
Average growth in per capita spending for cancer was slightly lower than the average for all disease categoriesAverage annual growth in expenditures by disease category (per capita), price index by disease category (cost to treat each case), and real
expenditures by disease category (number of treated cases), 2000 - 2012
Spending per capita Cost to treat each case Number of treated cases0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
5.0%4.6%
1.3%
5.4%
4.4%
1.9%
Cancer All diseases
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Peterson-Kaiser Health System Tracker
Diagnosis with a serious or chronic health condition is associated with higher health spending
Stroke Emphysema Diabetes Heart Disease
Cancer Arthritis High Blood Pressure
High Cholesterol
Asthma$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
$16,000
$14,
868
$13,
947
$12,
913
$12,
166
$11,
516
$10,
253
$8,7
42
$8,2
85
$6,7
33
$4,7
73
$4,9
76
$4,3
49
$3,4
32
$4,4
11
$3,3
66
$3,3
17
$3,7
40
$4,1
71
Ever been diagnosed Never diagnosed
Source: Kaiser Family Foundation analysis of Medical Expenditure Panel Survey, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services
Average health spending per person based on diagnosis status, in U.S. Dollars, 2013
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Peterson-Kaiser Health System Tracker
People with a diagnosis of a serious or chronic health condition face higher average out-of-pocket costs
Cancer Stroke Emphysema Heart Disease
Diabetes Arthritis High Cholesterol
High Blood Pressure
Asthma$0
$200
$400
$600
$800
$1,000
$1,200
$1,400
$1,600
$1,4
19
$1,3
36
$1,3
02
$1,2
94
$1,2
59
$1,2
21
$1,0
63
$1,0
44
$836
$635
$693
$706
$522
$661
$540
$561
$550
$586
Ever been diagnosed Never diagnosed
Source: Kaiser Family Foundation analysis of Medical Expenditure Panel Survey, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services
Average out-of-pocket spending per person based on diagnosis status, in U.S. Dollars, 2013
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Peterson-Kaiser Health System TrackerSource: Express Scripts 2014 Drug Trend Report
Cancer medications were among the top 3 conditions for specialty drug spending in 2014
Express Scripts per-member-per-year spending, top 10 specialty therapy class drugs, 2014
Transplant
Pulmonary Arterial Hypertension
Hemophilia
Growth Deficiency
Miscellaneous Specialty Conditions
HIV
Hepatitis C
Oncology
Multiple Sclerosis
Inflammatory conditions
$0 $10 $20 $30 $40 $50 $60 $70 $80 $90
$5.13
$5.41
$5.49
$9.98
$11.10
$27.24
$37.95
$41.64
$52.36
$80.03
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Peterson-Kaiser Health System Tracker
Source: World Lung Foundation and The American Cancer Society. The Tobacco Atlas. Available at: http://www.tobaccoatlas.org/topic/cigarette-use-globally/ (Accessed on January 5, 2016).
Per capita cigarette consumption is lower in the United States than in comparably wealthy countriesNumber of cigarettes smoked per capita per year, age 15+, 2014
United Kingdom
Sweden
Australia
France
United States
Canada
Comparable Country Average
Netherlands
Germany
Switzerland
Japan
Austria
Belgium
0 500 1000 1500 2000 2500
827
831
956
993
1,083
1,154
1,393
1,396
1,480
1,634
1,713
1,988
2,353
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Peterson-Kaiser Health System Tracker
Source: Kaiser Family Foundation analysis of data from the University of Washington Institute for Health Metrics and Evaluation. Available at: http://ghdx.healthdata.org/global-burden-disease-study-2013-gbd-2013-data-downloads (Accessed on November 23, 2015).
The U.S. has higher than average disease burden from lung cancerLung, tracheal, and bronchus cancer age-standardized disability adjusted life years (DALY) rate per 100,000 population, 2013
Japan
Sweden
Australia
Switzerland
Austria
Germany
Comparable Country Average
United Kingdom
Canada
France
United States
Belgium
Netherlands
0 100 200 300 400 500 600 700 800 900 1000
425
442
531
537
601
641
646
663
773
795
795
823
873