Cancer care cost trends in the United States: 1998 to 2012.

BACKGROUND

The authors examine trends in spending on cancer from 1998 through 2012, including cancer care costs, prevalence, and cases by payer, and discuss the results within the context of a prior analysis and recent health policy and programmatic changes.

METHODS

Condition-specific distribution of expenditures from the Medical Expenditure Panel Survey, supplemented with results from the National Nursing Home Survey and other data sources, was used as the basis for allocating the Personal Health Care components of the National Health Expenditure Accounts among conditions.

RESULTS

Cancer care expenditures grew at an annualized rate of 2.9% from 1998 to 2012. The share of expenditures for hospital-based care declined to a low of 48% during 2007 through 2009. Professional and clinical services' shares declined substantially between 2007 to 2009 and 2010 to 2012 when the hospital share increased. Treated prevalence decreased for all payers between the first and last study periods with the exception of private payers (11.2% increase). Out-of-pocket expenditures declined to 4.7%, whereas Medicare's share increased slightly. Medication expenditures increased, notably within retail and mail order settings.

CONCLUSIONS

The previous rapid growth of cancer prevalence and expenditures has now slowed, most remarkably since the 2007 recession. Out-of-pocket expenses for cancer treatment continue to decline, most recently reaching the lowest point in 25 years. In addition, the early effects of Affordable Care Act expansion can be observed in the decline of treated prevalence in the Medicaid population as the demographics of Medicaid enrollees change.