Cancer's growing burden: the high cost of care
The battle is not just about finding cures and better treatments
Patients, taxpayers and insurers are struggling with the cost of care for many diseases. One of the costliest is cancer.
Patti Tyree was afraid that cancer would steal her future. Instead, the cost of treating it has.
She had hoped to buy a small farm with money inherited from her mother. But co-payments for just one $18,000 round of breast chemotherapy and one shot of a nearly $15,000 blood-boosting drug cost her $2,000.
Bills for other treatments are still coming, and almost half of her $25,000 inheritance is gone.
"I supposedly have pretty good insurance," said Tyree, 57, a recently retired federal worker who lives near Roanoke, Va. "How can anybody afford this?"
Forty years after the National Cancer Act launched the "war on cancer," the battle is not just finding cures and better treatments but also being able to afford them.
New drugs often cost $100,000 or more a year. Patients are being put on them sooner in the course of their illness and for a longer time — sometimes for the rest of their lives. The latest trend is to use these drugs in combination, guided by genetic tests that allow more personalized treatment but also add to its expense.
It's not just drugs: Radiation treatment is becoming more high-tech, and each leap in technology has brought a quantum leap in expense. Proton therapy is one example — it costs twice as much as conventional radiation and is attracting prostate cancer patients despite a lack of evidence that it is any better.
The financial strain is showing: Some programs that help people pay their bills have seen a rise in requests, and medical bills are a leading cause of bankruptcies.
"Patients have to pay more for their premiums, more for their co-payments, more for their deductibles. It's become harder to afford what we have, and what we have is becoming not only more costly but also complex," said Dr. Michael Hassett, a cancer specialist and policy researcher at Dana-Farber Cancer Institute in Boston.
Insurers also are being squeezed by laws that require coverage and restrict raising premiums. And the burden is growing on Medicare, which in some cases is paying for treatments and tests that have not been shown to benefit patients.
Why have costs escalated so much?
To some extent, it's the price of success.
Cancer deaths have been declining in the United States since the early 1990s. Two out of 3 people now live at least five years after a cancer diagnosis, up from 1 out of 2 in the 1970s, according to the American Society of Clinical Oncology, doctors who treat the disease. Nine out of 10 women with early-stage breast cancer are alive five years after their diagnosis and are probably cured.
Modern treatments have fewer side effects and allow patients to have a greater quality of life than chemotherapy did in the past. But they are far more toxic financially.
Of the nation's 10 most expensive medical conditions, cancer has the highest per-person price. The total cost of treating cancer in the U.S. rose from about $95.5 billion in 2000 to $124.6 billion in 2010, the National Cancer Institute estimates. The true tab is higher — the agency bases its estimates on average costs from 2001-2006, before many expensive treatments came out.
Cancer costs are projected to reach $158 billion, in 2010 dollars, by the year 2020, because of a growing population of older people who are more likely to develop cancer.
That's the societal cost. For individual patients, costs can vary widely even for the same drug. Dr. Bruce Roth, a cancer specialist at Washington University in St. Louis, tells of Zytiga, a prostate cancer medicine approved last year. It costs $6,100 a month and insurers differ on how much they cover.
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