As Cancer Treatment Costs Soar, Young People Pay the Most

The rising cost of cancer care, with new drugs priced at $100,000 or more a year, worries policymakers and analysts concerned about the high healthcare bill in the United States.

And here’s something else for them to consider: A new study has found that those costs are highest for younger people.

The analysis, led by a researcher at Kaiser Permanente Center for Health Research in Portland, found that cancer treatment costs for people between 18 and 64 years old were higher than for seniors.

The result is surprising because fewer younger people are treated for cancer, 6.5 million compared to 9 million seniors, according to the U.S. Agency for Healthcare Research and Quality.

Matthew Banegas, a Kaiser researcher and the lead author of the study, said younger patients are often more likely to receive more intense treatment and potentially more expensive cancer therapies than older people. They tend to suffer from fewer chronic health problems and complications that could make more intense treatment difficult.

These patients are more likely to live longer as well.

“The five-year survival rates have improved across the board for people who are diagnosed with cancer, even (compared to) a decade ago,” Banegas said. “Those individuals who are diagnosed in their younger ages may live well into late in life.”

According to the U.S. Census, those 65 and older make up about 15 percent of population, about 50 million people. Although the ranks of older people are growing, nearly 40 percent of U.S. residents are aged 18 to 64, about 124 million.

The National Cancer Institute estimates that about 40 percent of both men and women will be diagnosed with cancer at some point in their life. The institute expects cancer costs to keep rising, from nearly $130 billion in 2010 to $160 billion by 2020, less than two years away.

Soaring costs are straining the healthcare system.

“It’s a big enough of a concern that our government agencies and major cancer organizations in the U.S. have started to join forces to (figure out) what to do to rein in costs,” Banegas said. “That’s why you’re starting to see new payment models or strategies for us to really address that.”

One model involving payment for bundled services rather than itemized billing is being tested by the Centers for Medicare & Medicaid.

Banegas said his study, which looked at medical care costs among patients diagnosed with cancer from 1988 through 2007, fills a gap by considering younger patients. Previous analyses have largely focused on seniors.

The study, published in the journal for the National Comprehensive Cancer Network, analyzed treatment costs for about 45,500 patients with lung, breast, colorectal or prostate cancer patients at four healthcare organizations: Kaiser Permanente Northwest in Portland, Group Health Cooperative which is now Kaiser Permanente Washington in Seattle, Henry Ford Health System in Detroit and Kaiser Permanente Colorado, located in Denver.

It found that care for patients diagnosed at the stage IV, the last one, was more expensive that those treated earlier, stage I or II. One reason is that patients diagnosed early may only need surgery, he said, rather than undergoing extensive chemotherapy or having long and repeated stays in the hospital.

Later stage tumors are often treated with newer drugs, which tend to be the most expensive. Take tisagenlecleucel, approved by the Food and Drug Administration last year. Marketed as Kymriah, it’s designed to treat a type of leukemia in children and young adults. The price tag: $475,000.

Studies have shown that drugs account for about one-third of cancer care costs.

Overall, Kaiser-led study found total costs were highest for lung cancer treatment, which ranged from almost $51,000 for the first year for younger patients with a stage I diagnosis to nearly $98,000 for the same group at stage IV.  For seniors, lung cancer care ranged from $44,000 for the first year with a stage I diagnosis to about $71,000 at stage IV.

Breast cancer was the next most expensive treatment. One year of care for younger patients ranged from $34,000 at stage I to nearly $93,000 at stage IV. That compares with $34,000 to $85,000 for colorectal cancer and $18,000 to 27,000 for prostate cancer.

The study highlights the need for the health care system to focus on  cancer prevention and early treatment, especially when it comes to younger people.

“We need to invest in that population earlier for prevention and screening so we can reduce future costs,” he said.

Freelance writer Lynne Terry is a veteran healthcare reporter based in Portland.