Peterson-Kaiser Health System Tracker What are recent trends in cancer spending and outcomes?

Peterson-Kaiser Health System Tracker

What are recent trends in cancer spending and outcomes?


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


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


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


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)


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


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


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


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



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


Injuries

Musculoskeletal 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



U.S. disease burden has decreased in past two decades for circulatory, cancer, injuries, and neonatal disorders

Skin diseases

Neonatal*

Chronic respiratory

Nervous System


Injuries*

Musculoskeletal disorders

Cancers and tumors (Neoplasms)*


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



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

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%


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


Circulatory Diseases


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


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



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%



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


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


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

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


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


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

http://www.tobaccoatlas.org/topic/cigarette-use-globally/

http://www.tobaccoatlas.org/topic/cigarette-use-globally/


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


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

http://ghdx.healthdata.org/global-burden-disease-study-2013-gbd-2013-data-downloads

Peterson-Kaiser Health System Tracker What are recent trends in cancer spending and outcomes?

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