Projections of the Cost of Cancer Care in the United States: 2010-2020
Projections of the Cost of Cancer Care in the United States: 2010-2020
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DOI：
10.1093/jnci/djq495
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发表时间：
2011-01-01
影响因子：
10.3
通讯作者：
Brown, Martin L.
中科院分区：
文献类型：
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作者：
Mariotto, Angela B.;Yabroff, K. Robin;Brown, Martin L.
背景 目前对美国癌症治疗费用的估计是基于 2003 年及之前的数据。然而，大多数癌症的发病率、生存率和实践模式一直在变化。方法到 2020 年，根据护理阶段（诊断后的第一年、持续治疗和生命的最后一年）和肿瘤部位，对 13 种男性癌症和 16 种女性癌症的癌症患病率进行了估计和预测。癌症患病率是根据监测、流行病学和最终结果 (SEER) 计划数据估计的癌症发病率和生存模型计算得出的。年化净成本是根据最近的 SEER-Medicare 关联数据估算的，其中包括 2006 年之前诊断为癌症的 65 岁及以上受益人的索赔情况。从居住在 SEER 地区的所有 Medicare 受益人的 5% 随机样本中确定未患癌症的对照受试者，以调整与癌症无关的支出。所有成本估算均调整为 2010 年美元。通过敏感性分析评估了关于发病率、生存率和成本未来趋势假设的不同情景。结果 假设发病率、生存率和费用保持不变，我们预计 2010 年和 2020 年癌症幸存者分别为 13.8 和 1810 万，2010 年癌症护理的相关费用分别为 124.57 和 1577.7 亿美元。医疗费用增加 27% 仅反映了美国人口的变化。增幅最大的是前列腺癌 (42%) 和女性乳腺癌 (32%) 的持续护理阶段。对当前发病率（下降）和生存率（上升）趋势的预测对 2020 年的估计影响很小。然而，如果在生命最初阶段和最后一年的护理费用每年增加 2%，那么 2020 年的总费用预计将达到 1,730 亿美元，比 2010 年增加 39%。 结论 全国癌症护理费用相当可观，并且仅由于人口变化，预计就会增加。我们的研究结果对决策者规划和分配资源具有影响。
Background Current estimates of the costs of cancer care in the United States are based on data from 2003 and earlier. However, incidence, survival, and practice patterns have been changing for the majority of cancers.Methods Cancer prevalence was estimated and projected by phase of care (initial year following diagnosis, continuing, and last year of life) and tumor site for 13 cancers in men and 16 cancers in women through 2020. Cancer prevalence was calculated from cancer incidence and survival models estimated from Surveillance, Epidemiology, and EndResults (SEER) Program data. Annualized net costs were estimated from recent SEER-Medicare linkage data, which included claims through 2006 among beneficiaries aged 65 years and older with a cancer diagnosis. Control subjects without cancer were identified from a 5% random sample of all Medicare beneficiaries residing in the SEER areas to adjust for expenditures not related to cancer. All cost estimates were adjusted to 2010 dollars. Different scenarios for assumptions about future trends in incidence, survival, and cost were assessed with sensitivity analysis. Results Assuming constant incidence, survival, and cost, we projected 13.8 and 18.1 million cancer survivors in 2010 and 2020, respectively, with associated costs of cancer care of 124.57 and 157.77 billion 2010 US dollars. This 27% increase in medical costs reflects US population changes only. The largest increases were in the continuing phase of care for prostate cancer (42%) and female breast cancer (32%). Projections of current trends in incidence (declining) and survival (increasing) had small effects on 2020 estimates. However, if costs of care increase annually by 2% in the initial and last year of life phases of care, the total cost in 2020 is projected to be $173 billion, which represents a 39% increase from 2010.Conclusions The national cost of cancer care is substantial and expected to increase because of population changes alone. Our findings have implications for policy makers in planning and allocation of resources.