Pennsylvania State University College of Medicine investigators have found that the 15 most prevalent types of cancer in the US cost approximately $156.2 billion in 2018, with medication representing the biggest expense for breast, lung, lymphoma, and colorectal cancers.

The investigators examined a database that included statistics on cancer care for the 402,115 privately insured patients with cancer below the age of 65 in the US. The aim of the study was to gather data to help understand how money is being spent on cancer care, which has traditionally been difficult to track, mainly because the US has different ways to cover health care costs, such as private insurance for people younger than 65 years of age and Medicare for people 65 and over.

“Cancer is a leading cause of death, actually overtaking heart disease as the leading cause of death in the US over the past few years,” said Nicholas Zaorsky, MD, MS, researcher and assistant professor from the departments of radiation oncology and public health sciences at Penn State Cancer Institute, in a statement. “But it’s still unknown what we pay for in cancer care. As a team, we wanted to look at what private insurances are paying for each kind of cancer and for each type of service.”

The investigators assessed a database that included 38.4 million types of Current Procedure Terminology codes for the 15 cancers, including breast, prostate, colorectal, lung, lymphoma, melanoma, uterus, head and neck, bladder, kidney, thyroid, stomach, liver, pancreas, and esophagus cancers. The cohort study used 2018 data, the most recent complete numbers available, from the IBM Watson Health MarketScan.

The sample included 27.1 million privately insured individuals, including patients with the most prevalent cancers.

Breast cancer incurred the most services, about 10.9 million services and procedures, followed by colorectal cancer, which had approximately 3.9 million services listed in the database. Breast cancer was also the most expensive type of cancer, costing a total of $3.4 billion, followed by lung cancer and colorectal cancer, which were both estimated to incur around $1.1 billion in costs.

Drug costs represent the most expensive category for treating patients with cancer. Approximately $4 billion was spent on cancer related drugs, which is twice the $2 billion spent on surgeries. Other direct costs included diagnostic tests, hospital fees, and physician fees.

Pathology and laboratory tests accounted for the highest number of services performed in the study, although the drug therapies cost more than these services.

Investigators noted that these figures highlight discrepancies between the spending associated with different types of cancer but does not offer an explanation to justify these variations.

For example, pancreatic cancer is one of the deadliest cancers, yet the total cost of care devoted to pancreatic cancer is relatively low compared with indolent prostate cancer.

Future research should seek to determine which services are of the most and least value to patients, factors/parameters, etc, that may or may not be directly correlated with higher costs. Furthermore, identifying areas of high out-of-pocket costs will also be an important part of reshaping policy to ease patient burden and improve quality of life for patients with cancer. 

Zaorsky NG, Khunsriraksakul C, Acri SL, et al. Medical service use and charges for cancer care in 2018 for privately insured patients younger than 65 years in the US. JAMA Netw Open. 2021;4(10):e2127784. doi:10.1001/jamanetworkopen.2021.27784

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Medication is the biggest expense for breast, lung, lymphoma, and colorectal cancers.

Cancer Care Costs US Billions— Mostly in Drug Expenses

The coronavirus disease 2019 (COVID-19) pandemic took what was mostly niche telehealth technology and brought it to a much larger patient population. But as the novelty has worn off and people have regained confidence in going to in-person appointments, both the government and private payers have begun making moves that will impact the technology’s long-term viability.

®, spoke with Thomas Conroy, CEO of MedSign, about how telehealth is viewed and what its future might look like.

: With the massive expansion of telehealth during the pandemic, how well has it worked out for clinicians and patients?

: In the beginning, telehealth was positioned for rural areas and now it’s across the nation. I think it’s a learning process. Because of COVID-19 and the inability to get the physician’s office, telehealth has opened up the door, but we have got to do a lot more than that. We need to make some technology changes to enable those who are, let’s say, technology averse, to access telehealth, in the comfort of their home, and I’m talking about seniors.

So I think overall, for [clinicians], you’ll find that the younger [clinicians] are totally open-minded and want to embrace telehealth and maybe the older doctors are the type that would like to see the patient in the home. And they’re going to learn over time that this is an incredible tool that they’ll have in their war chest to help to keep people healthy and well in the home.

Medical Economics®: In the past, Medicare primarily focused telehealth benefits on rural areas where care could often be hard to access. Is that the right approach?

 CMS took what they were doing in the rural areas and applied it to a nationwide program. It was a great way to start, and they understood some of the shortfalls there. What we need to do though…is make sure that the information that’s provided and the connectivity that is provided is for all Americans, and not just the young people today. They all understand just having happiness in your hand in the form of a cell phone is the way to go, because that’s what they live by. We’re going to see more and more of that as we progress in the telehealth arena. But we have to embrace those people and get others to adopt the system, and I think CMS has done that in the beginning here very well.

®: Many patients who used telehealth have since returned to in-office visits, and doctors who reported a lot of telehealth usage in early 2020 now say it’s declined. What does that say about the long-term future for telehealth?

 I think this is a generation issue. The old generation wants to be able to go into the doctor’s office, look them in the whites of their eyes, and get the people to care for them personally. The young people [are] used to the use of technology that exists today, and it’s just only going to grow. We’re not really seeing a real reduction, but an increase in in-home and in-office care. What we are seeing is that the seniors would like to actually talk and see the doctors themselves. Well, that will change over time as telehealth becomes commonplace.

And what you really have to consider is, there’s another area of seniors that is really important: those who have chronic diseases. They don’t want to go to the hospitals, they don’t want to see their doctors, they want to sit and stay in the comfort of their home, but you have to provide technology that enables them to do that.

There’s technology out there, like the one that I’m working on, that enables the seniors to talk to the physician or their nurse, or even their loved one, through the comfort of their home using a home television set. And I think that if we can apply that common technology that is in 120 million homes, we get to sell a winner here. 

When we talk about the seniors, you have to provide them what they know best, and that’s access to a product that they use every day in their home, and it’s a television set. So that will be the embracement part. The adoption part that telehealth needs is that you have to bring in those people who are pretty much using most of the Medicare and Medicaid dollars. It’s the seniors over 75 years of age especially. And here’s the other thing: That population is growing. Think about it: Because of all the health care that they’re receiving, they are living longer. We have to make sure that we can embrace those folks, and the way you do it is providing technology so that they can adopt it with ease.

The pandemic brought telehealth into the mainstream, but will it stay there after the COVID-19 pandemic is over, especially as the population ages?

Todd Shryock

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Cancer Care Costs US Billions— Mostly in Drug Expenses

Telehealth: Hope or Hype?