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The Economics of Cancer Care

Worldwide, cancer was the second leading cause of mortality in 2013, with 8.2 million deaths (and 14.9 million incident cancer cases, compared to 8.5 million incident cases in 1990). Decomposition analyses revealed that a 5% increase of the incidence was attributable to a change in incidence rates, whereas 36% were due to a change in the population age structure [1]. If demographic trends don’t change, the global cancer burden is expected to exceed 20 million new cases and 13 million deaths by 2030 [2].

In 2013, the global burden of disease (or "intangible" cost of cancer) was estimated at close to 200 million disability-adjusted life years (DALYs, representing a combination of life years lost and years lived with disability due to cancer) in 2013 [1]. Aggregate data on the economic burden ("direct" and "indirect" costs) of cancer are estimates; the reliability of these projections is currently  limited by the vast heterogeneity of the underlying data sources.

In particular, methods for identifying patients vary, and little consideration has been given to the issue of how best to combine the various estimates (based on different data sources and population samples) in a meaningful way.

Currently available estimates of the total cost of cancer in Europe (and Germany) suggest a dimension of €126 billion in the EU in 2009 (hereof, Germany, €35 billion), with health care accounting for €51 billion (Germany, €15 billion); productivity losses, €52 million (Germany, €14 billion); informal care, €23 billion (Germany, €6 billion) [3].

Irrespective of the exact absolute levels of health care spending and productivity losses due to cancer, it is safe to predict that demographic trends will cause further substantial growth of the burden of cancer in the foreseeable future, on a global scale as well as in Europe [1-6].

Against this background, the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) established a new division of health economics, effective 2017, which will address the cost of cancer and the cost effectiveness of cancer care. More information on this initiative will be provided in due course.

Data sources:

  1. Fitzmaurice, C., et al.: The global burden of cancer 2013. JAMA Oncol. 2015; 1 (4): 505-527
  2. American Cancer Society: Cancer Facts & Figures 2017. Atlanta, GA: American Cancer Society, 2017
  3. Luengo-Fernandez, R., et al.: Economic burden of cancer across the European Union: a population-based cost analysis. Lancet Oncol. 2013; 14: 1165–74

Further references, providing U.S. data of interest:

  1. Mariotti, A.B.: Projections of the cost of cancer care in the United States: 2010–2020. J. Natl. Inst. Cancer 2011; 103: 117–128
  2. Agency for Healthcare Research and Quality (AHRQ): Table 3: Total Expenses and Percent Distribution for Selected Conditions by Type of Service: United States, 2013. Medical Expenditure Panel Survey Household Component Data. Generated interactively May 12, 2016; quoted from Centers for Disease Control and Prevention (CDC) website at accessed January 29, 2017
  3. Yabroff, K.R., et al.: Economic burden of cancer in the US: estimates, projections, and future research. Cancer Epidemiol. Biomarkers Prev. 2011; 20 (19): 2006-2014