What are recent trends in cancer spending and
outcomes?
Peterson-Kaiser Health System Tracker
Unlike the other leading causes of death, cancer mortality
rates are lower in the U.S. than in comparable countries
Age-adjusted major causes of mortality per 100,000 population, in years, 2010
Comparable Country Average
United States
243
Diseases of the circulatory system
265
212
203
Cancers and tumors (Neoplasms)
63
Diseases of the respiratory system
82
43
External causes of mortality
60
29
Diseases of the nervous system
48
29
Mental and behavioral disorders
40
23
Endocrine, nutritional and metabolic diseases
34
0
50
100
150
200
250
300
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.
Peterson-Kaiser Health System Tracker
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
Netherlands
247
United Kingdom
231
Belgium
224
France
216
Canada
215
Germany
212
Comparable Country Average
212
Austria
210
Australia
206
United States
203
Sweden
196
Japan
191
Switzerland
188
0
50
100
150
200
250
300
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.
Peterson-Kaiser Health System Tracker
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
300
262
250
242
Comparable
212 country average
203
United States
200
150
100
50
0
1980
1985
1990
1995
2000
2005
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.
Peterson-Kaiser Health System Tracker
Mortality rates for breast and colorectal cancer in the
U.S. are lower than in comparable countries
Age-standardized mortality rate per 100,000 population for breast, colorectal, and cervical cancer, in years, (2010)
United States
Comparable Country Average
30
27.1
25
24.9
22.8
20
18
15
10
5
2.5
2.3
0
Breast Cancer
Colorectal Cancer
Cervical Cancer
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.
Peterson-Kaiser Health System Tracker
Five-year survival for breast and colorectal cancers are
increasing
Percentage of age-adjusted five-year relative survival for breast, colorectal, and cervical cancer, all ages, in years 1990-1992 and 2005-2011
1990-1992
2005-2011
100%
90.7%
90%
85.4%
80%
66.1%
70%
69.6%
69.3%
61.4%
60%
50%
40%
30%
20%
10%
0%
Breast Cancer
Colorectal Cancer
Cervical Cancer
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.
Peterson-Kaiser Health System Tracker
Five-year survival rates for certain cancers are slightly
higher in the U.S. than in comparable countries
Percentage of age-adjusted five-year relative survival for breast, colorectal, and cervical cancer, ages 15-99, in years 2006-2011
United States
Comparable Country Average
100%
90%
88.9%
85.4%
80%
70%
64.2%
62.9%
61.8%
66.1%
60%
50%
40%
30%
20%
10%
0%
Breast Cancer
Colorectal Cancer
Cervical Cancer
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.
Peterson-Kaiser Health System Tracker
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
Circulatory
3,207
Cancers and tumors (neoplasms)
2,913
Injuries
1,882
Nervous System
627
Chronic Respiratory
594
Neonatal
445
Mental and behavioral disorders
441
Cirrhosis of the liver
342
Digestive
163
Endocrine (diabetes)
151
-
500
1,000
1,500
2,000
2,500
3,000
3,500
Source: Institute for Health Metrics and Evaluation. Global Burden of Disease Study Data Downloads, available here: http://ghdx.healthdata.org/globalburden-disease-study-2013-gbd-2013-data-downloads
Peterson-Kaiser Health System Tracker
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
Circulatory
3,920
Mental and behavioral disorders
3,266
Cancers and tumors (Neoplasms)
3,133
Musculoskeletal disorders
2,804
Injuries
2,519
Endocrine (diabetes)
1,773
Nervous System
1,487
Chronic respiratory
1,424
Neonatal
672
Skin diseases
629
-
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
Source: Institute for Health Metrics and Evaluation. Global Burden of Disease Study Data Downloads, available here: http://ghdx.healthdata.org/globalburden-disease-study-2013-gbd-2013-data-downloads
Peterson-Kaiser Health System Tracker
U.S. disease burden has decreased in past two decades
for circulatory, cancer, injuries, and neonatal disorders
Age standardized disability adjusted life years (DALYs) rate per 100,000 population, both sexes, 1990 and 2013
1990
2013
Circulatory*
6,007
3,920
2,948
3,266
Mental and behavioral disorders
Cancers and tumors (Neoplasms)*
3,133
3,862
2,657
2,804
Musculoskeletal disorders
Injuries*
2,519
3,519
1,542
1,773
Endocrine (diabetes)
Nervous System
1,426
1,487
Chronic respiratory
1,460
1,424
922
672
Neonatal*
634
629
Skin diseases
-
1,000
2,000
3,000
4,000
5,000
6,000
7,000
Source: Institute for Health Metrics and Evaluation. Global Burden of Disease Study Data Downloads, available here: http://ghdx.healthdata.org/globalburden-disease-study-2013-gbd-2013-data-downloads
Peterson-Kaiser Health System Tracker
Disease burden due to cancer is most caused by lung
cancer; for both males and females
MALES
Age standardized disability adjusted life years (DALYs) rate per
100,000 population, males in the U.S., 2013
Lung and related
FEMALES
Age standardized disability adjusted life years (DALYs) rate per
100,000 population, females in the U.S., 2013
1,251
Lung and related
Colon and rectal
457
Breast
Prostate
457
Colon and rectal
Pancreatic
281
894
694
351
Pancreatic
225
224
Other neoplasms
206
Ovarian
Non-Hodgkin lymphoma
203
Other neoplasms
Leukemia
194
Non-Hodgkin lymphoma
132
Liver
186
Leukemia
124
Esophageal
171
Brain and nervous system
108
Brain and nervous system
166
Cervical
107
-
500
1,000
1,500
183
-
500
1,000
Source: Institute for Health Metrics and Evaluation. Global Burden of Disease Study Data Downloads, available here: http://ghdx.healthdata.org/globalburden-disease-study-2013-gbd-2013-data-downloads
Peterson-Kaiser Health System Tracker
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
95%
94%
94.3%
93%
92%
91%
90%
89%
88%
88.4%
87%
86%
85%
2004
2005
2006
2007
2008
2009
2010
Source: Commission on Cancer, American College of Surgeons and American Cancer Society, National Cancer Data Base
Peterson-Kaiser Health System Tracker
2011
Recent decline in U.S. mortality rates largely reflects
improvement for circulatory diseases
Overall age-adjusted mortality rate per 100,000 population
1400
1200
Other Causes
1000
Endocrine, Nutritional and Metabolic
Mental and Behavioral Disorders
800
Accidents, Suicides and External
Causes
600
Respiratory Diseases
400
Cancers and tumors (Neoplasms)
200
0
1980
Circulatory Diseases
1985
1990
1995
2000
2005
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-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.
Peterson-Kaiser Health System Tracker
Cancer spending accounts for about 7% of disease
based health expenditures
Total expenditures in US $ billions by disease category, 2012
Pregnancy, birth, $39
Dermatological, $44
Infectious diseases, $67
Other,
$93
Ill-defined
conditions, $247
Mental Illness, $80
Digestive, $107
Circulatory,
$243
Genitourinary,
$113
Injury, $118
Musculoskeletal,
$188
Respiratory,
$158
Cancers, $124
Nervous system, $133
Endocrine, $138
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.
Peterson-Kaiser Health System Tracker
On a per capita basis, the U.S. spends about $394 per
year to treat cancer, up from $219 in 2000
Per capita expenditures on the treatment of cancers and tumors (neoplasms), US $, 2000 - 2012
$450
$400
$350
$300
$250
$219
$241
$257 $268
$290 $301
$322 $335
$352
$375 $379
$394 $394
$200
$150
$100
$50
$0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
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.
Peterson-Kaiser Health System Tracker
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
Ill-defined conditions
16.6%
Musculoskeletal
11.0%
Circulatory
8.6%
Endocrine
8.5%
Nervous system
7.4%
Respiratory
6.5%
Cancer
6.3%
Other
6.2%
Genitourinary
5.9%
Injury and poisoning
5.3%
Digestive
5.1%
Infectious diseases
4.4%
Mental illness
4.1%
Dermatological
2.3%
Pregnancy/childbirth
1.7%
0%
2%
4%
6%
8%
10%
12%
14%
16%
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.
Peterson-Kaiser Health System Tracker
18%
Average growth in per capita spending for cancer was
slightly lower than the average for all disease categories
Average 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
6.0%
5.0%
5.4%
Cancer
All diseases
5.0%
4.6%
4.4%
4.0%
3.0%
1.9%
2.0%
1.3%
1.0%
0.0%
Spending per capita
Cost to treat each case
Number of treated cases
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.
Peterson-Kaiser Health System Tracker
Diagnosis with a serious or chronic health condition is
associated with higher health spending
Average health spending per person based on diagnosis status, in U.S. Dollars, 2013
Ever been diagnosed
Never diagnosed
$4,171
$6,733
$8,285
$3,740
$3,366
$4,411
$3,432
$4,349
$2,000
$4,976
$4,000
$4,773
$6,000
$3,317
$8,000
$8,742
$10,253
$11,516
$10,000
$12,166
$12,913
$12,000
$13,947
$14,000
$14,868
$16,000
$0
Stroke
Emphysema
Diabetes
Heart
Disease
Cancer
Arthritis
High Blood
High
Pressure Cholesterol
Asthma
Source: Kaiser Family Foundation analysis of Medical Expenditure Panel Survey, Agency for Healthcare Research and Quality, U.S. Department of Health
and Human Services
Peterson-Kaiser Health System Tracker
People with a diagnosis of a serious or chronic health
condition face higher average out-of-pocket costs
Average out-of-pocket spending per person based on diagnosis status, in U.S. Dollars, 2013
Ever been diagnosed
Never diagnosed
$586
$836
$550
$561
$540
$522
$400
$661
$706
$693
$600
$635
$800
$1,044
$1,063
$1,000
$1,221
$1,259
$1,294
$1,302
$1,200
$1,336
$1,400
$1,419
$1,600
$200
$0
Cancer
Stroke
Emphysema
Heart
Disease
Diabetes
Arthritis
High
High Blood
Cholesterol Pressure
Asthma
Source: Kaiser Family Foundation analysis of Medical Expenditure Panel Survey, Agency for Healthcare Research and Quality, U.S. Department of Health
and Human Services
Peterson-Kaiser Health System Tracker
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
Inflammatory conditions
$80.03
Multiple Sclerosis
$52.36
Oncology
$41.64
Hepatitis C
$37.95
HIV
$27.24
Miscellaneous Specialty Conditions
$11.10
Growth Deficiency
$9.98
Hemophilia
$5.49
Pulmonary Arterial Hypertension
$5.41
Transplant
$5.13
$0
Source: Express Scripts 2014 Drug Trend Report
Peterson-Kaiser Health System Tracker
$10
$20
$30
$40
$50
$60
$70
$80
$90
Per capita cigarette consumption is lower in the United
States than in comparably wealthy countries
Number of cigarettes smoked per capita per year, age 15+, 2014
Belgium
2,353
Austria
1,988
Japan
1,713
Switzerland
1,634
Germany
1,480
Netherlands
1,396
Comparable Country Average
1,393
Canada
1,154
United States
1,083
France
993
Australia
956
Sweden
831
United Kingdom
827
0
500
1000
1500
2000
Source: World Lung Foundation and The American Cancer Society. The Tobacco Atlas. Available at: http://www.tobaccoatlas.org/topic/cigarette-useglobally/ (Accessed on January 5, 2016).
Peterson-Kaiser Health System Tracker
2500
The U.S. has higher than average disease burden from
lung cancer
Lung, tracheal, and bronchus cancer age-standardized disability adjusted life years (DALY) rate per 100,000 population, 2013
Netherlands
873
Belgium
823
United States
795
France
795
Canada
773
United Kingdom
663
Comparable Country Average
646
Germany
641
Austria
601
Switzerland
537
Australia
531
Sweden
442
Japan
425
0
100
200
300
400
500
600
700
800
900
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).
Peterson-Kaiser Health System Tracker
1000