October 7, 2015
When a doctor says the word cancer, a patient’s mind often enters complete shock. Then, questions emerge.
How serious? Is it treatable? What can I do? How long do I have?
Patients shouldn’t have to ask, “How much will this cost?”
But the cost of cancer is an aspect of growing importance in the conversation between healthcare providers and patients as drug prices continue to rise across the world.
Last week, the U.S. Food and Drug Administration approved a treatment for melanoma, a deadly skin cancer, which shrunk tumors in 60 percent of patients in a clinical trial.
The drug’s manufacturer, Bristol-Myers Squibb, will charge $141,000 for the first 12 weeks of treatment and $256,000 for a year of treatment, according to the Wall Street Journal. Experts fear the cost of the drug could keep some patients from receiving what could be the best care available.
Americans are growing increasingly irritated with the rising costs of cancer drugs and treatments.
A Kaiser Health Tracking poll found 76 percent of the public believe a top priority for the president and Congress should be making high-cost drugs for chronic conditions affordable.
Another Kaiser poll found 72 percent of Americans believe drug costs are unreasonable and 74 percent think Big Pharma cares more about profits than people.
The cost of cancer isn’t just affecting patients and their families either. It’s affecting society. Politicians offer new plans to increase votes, health institutions encourage doctors to ask patients for money and the workforce loses billions of dollars every year in lost production.
And the cost of cancer keeps rising.
Cost of Cancer on the Rise
Each year, cancer costs the world more money than any other disease, according to the American Institute of Cancer Research (AICR).
Cancer costs $895 billion annually. Comparatively, heart disease costs $753 billion. Nothing else comes close, with traffic accidents and diabetes each costing about $204 billion.
The price for one year of life increased to $139,100 in 2005 and $207,000 in 2013.
The biggest financial impact is in terms of loss of life and productivity, in which cancer accounts for 1.5 percent of global gross domestic product (GDP) losses. The AICR estimates Americans lost 83 million years of healthy life because of cancer deaths and disabilities in 2008.
More than half a million Americans die of cancer, the second-leading cause of death in the U.S., every year.
To breakdown the direct healthcare costs, the Agency for Healthcare Research and Quality (AHRQ) estimated cancer cost Americans $88.7 billion in 2011.
Of that cost:
- 50% came from hospital outpatient or doctor office visits
- 35% came from inpatient hospital stays
- 11% came from prescription drugs
And it’s getting more expensive.
A 2011 study in the Journal of the National Cancer Institute determined the cost of all cancer care in the U.S. totaled $124.5 billion in 2010. The researchers projected the total cost would rise to $157.7 billion by 2020. The projected cost increase by phase of treatment is displayed in the table below.
Cost of Cancer Care in Billions of 2010 Dollars
There doesn’t seem to be a good reason for the increase in cost though.
A 2015 National Bureau of Economic Research study found anticancer drug prices at launch increased by 10% ever year between 1995 and 2013, about an $8,500 annual increase. That’s after an adjustment for inflation and survival benefits.
When calculating the average cost for one extra year of life, the researchers determined patients and insurers paid $54,100 in 1995. The price for one year of life increased to $139,100 in 2005 and $207,000 in 2013.
Another study (2014) published in The Lancet found the costs of cancer are already unaffordable in many countries. In the U.S., even those with very good insurance coverage incur out-of-pocket costs or experience overexposure to harmful treatments.
Many people have no idea what to expect financially when their doctor gives them or a loved one the heartbreaking diagnosis.
Total Cost of Cancer Treatment
On an individual level, a cancer diagnosis isn’t limited to physical and emotional hardship. It can put someone in a hard spot financially too.
People may have to choose between more successful expensive treatments and less effective, affordable treatments.
Each person’s cost to treat cancer is different.
According to the American Cancer Society (ACS), factors to treat cancer include:
- The type of treatment
- The length of treatment
- The location of the treatment
- The type of insurance coverage
For people with health insurance, the concern might not be as great. But some insurance plans won’t cover the most expensive, sometimes most-necessary treatments.
Sadly, many cancer patients have to spend time and energy working out financial issues before treatment even begins. Others face financial struggles during treatment, and almost everyone spends precious energy trying to manage their money while recovering from treatment.
Major healthcare costs to consider include:
- Hospital and clinic visits
- Medicine and prescription drugs
- Lab tests
- Home health services
Cost of Surgery
Physically removing a tumor during surgery is one of the top ways to treat cancer. Doctors can use surgery to prevent, diagnose, remove, or debulk (remove as much as possible) cancer. They have a variety of methods to do so too, according to the MayoClinic.
Surgery methods include:
- Cryosurgery: freezing cancer cells to destroy them
- Electrosurgery: killing cancer cells with high-frequency current
- Laser surgery: killing cancer cells with beams of intense light
- Mohs surgery: removing cancer cells layer by layer
- Laparoscopic surgery: minimally-invasive surgery using small incisions
- Robotic surgery: use of 3-D imaging and computers to operate surgical tools
The costs per surgery vary greatly, depending on the hospital, insurance coverage and type of procedure.
A 2014 study examining the costs of surgery involving various types of cancer found average costs ranging from $14,161 to $56,587. The costs included admissions, readmissions, physician services and other costs (outpatient visits, hospice care, home health agencies or medical equipment).
Average Cost of Cancer Surgery
Cost of Chemotherapy
Chemotherapy is another way to treat cancer. It involves chemicals that kill fast-growing cells. Since cancer cells grow more quickly than other body cells, doctors often use chemotherapy to treat the disease.
According to an Avalere Health study which analyzed three years of data, the adjusted (based on age, sex and prior cancer history) cost of chemotherapy differed depending on location – in a doctor’s office or hospital’s outpatient department (HOPD).
Average Cost of Chemotherapy
The costs also differed depending on the type of cancer. The most expensive was colon cancer, which cost $45,997 in an office and $46,220 in an HOPD. The average costs for all lengths of treatment (averaging 3.8 months in an office and 3.4 months in an HOPD) ranged from $28,177 in an office to $34,973 in an HOPD.
Cost of Radiation Therapy
Radiation therapy is another form of expensive cancer treatment. It involves the use of intense energy beams, usually X-rays, to kill genetic material. The radiation kills both healthy cells and cancer cells, so the length of treatment is usually shorter than chemotherapy.
The Avalere Health study also analyzed the adjusted cost of radiation therapies at different locations.
Average Cost of Radiation Therapy
The costs of radiation therapy also differed by cancer type. The most expensive was prostate cancer, which cost $37,472 in an office and $29,800 in an HOPD. The average costs for all lengths of treatment (averaging 2.1 months in an office and 1.9 months in an HOPD) ranged from $25,144 in an office to $23,756 in an HOPD.
Most people think of healthcare costs when they think of the cost of cancer, but there are other costs that many don’t consider.
Hidden Costs During Cancer Treatment
Cancer affects people far more financially than they usually realize. The cost is not limited to hospital visits and clinical treatments. It often includes costs like traveling to specialized centers, lost income from having to miss work and new clothes or accessories.
According to the ACS, hidden costs include:
- Gas and parking expenses during visits to appointments
- Lodging during treatment on the road
- Meals while away from home
- Child care costs
- Communication costs, like copies of medical records
- Special nutritional supplements
- Special equipment or clothing
Additionally, some families hire someone to assist them with the challenges they face. They may hire someone to make meals and clean around the house.
Families often seek legal and financial guidance too. They may ask a lawyer to help them understand legal rights when dealing with employers or insurance companies, how to write a will or how to deal with medical professionals if something were to occur.
Families may seek help preparing income taxes with their new medical expenses, planning estates or granting a power of attorney.
Cancer’s Effect on Families
Treating cancer is often a team battle, and patients rely on the time and energy of friends and family to help them get through their challenging time.
Studies that compare caregivers of cancer patients to the general population show caregivers suffer economic ramifications. Many miss work and report work impairment. Caregivers are also more likely to suffer depression, anxiety, insomnia and migraines, requiring them to seek their own health treatment.
Unfortunately, families suffering from the loss of a loved one at the hands of cancer also have to deal with financial struggles at one of the most difficult times in their lives. Financial costs can include autopsies, funeral services, obituaries, death certificates, and settling estate and property claims.
Insurance’s Role in Cancer Costs
Health insurance is the biggest factor in the equation of personal healthcare costs for cancer patients. Insurance plans usually cover most major costs like doctor appointments, hospital stays, tests and procedures.
However, very few plans cover all of the costs in full. Almost all plans require co-payments for each appointment or visit. Tests and procedures often require patients to pay some money out of pocket too.
The most effective drugs and procedures are usually the most expensive. That means access to the treatment that can most successfully treat cancer often requires insurance. People without insurance usually don’t receive the best care available because they can’t afford it.
Fortunately, the Affordable Care Act (ACA) helped millions of Americans receive access to health insurance.
Affordable Care Act
President Barack Obama signed the ACA in March of 2010.
The ACA made drastic changes to many health insurance plans in terms of coverage and services offered.
Some of the changes that affect cancer patients and their families include:
- Health plans must cover people with a pre-existing condition, like cancer
- Cancer screening tests, such as mammograms and colonoscopies, must be available at little or no cost to patients
- Insurance plans can’t cancel coverage if patient gets sick
- Plans can’t charge ill people – including those with cancer – more than healthy people
- Plans can’t have annual and lifetime dollar limits for how much a provider will pay
- Plans can’t limit or drop coverage for a patient who chooses to participate in a clinical trial
- Young adults can stay on their parents’ plan until age 26
Even with the growing number of people covered by the ACA, about 11 percent of Americans were without health insurance through the first half of 2015, according to Gallup polls.
For people without insurance, the costs to treat cancer can be astronomical. Many people don’t realize health insurance providers aggressively negotiate costs of drugs and procedures.
An August study found uninsured cancer patients in North Carolina paid twice as much for doctor appointments and 43 times as much for chemotherapy as the amount people with insurance and their providers paid.
People who don’t have health insurance can ask doctors and hospitals for discounts. Patients can also ask for generics, although very few generic drugs are available for treating cancer.
Minimizing Cancer Treatment Expenses
There are other ways cancer patients can attempt to minimize expenses. Many hospitals provide case managers or have social workers who work on site to help patients and their families deal with the emotional and financial hardships they face.
Doctors and nurses can also provide referrals to a number of support services and financial resources available to cancer patients.
Local and national service organizations and government assistance programs may offer grants to help pay for some services or medications.
It’s also important to learn what insurance will cover when participating in a clinical trial. Insurers can’t drop coverage if a patient participates in a trial, but some plans do not cover “experimental” or “investigational” treatments.
Some plans only cover tests or doctor’s visits that would have been part of a treatment plan if it weren’t for clinical trial participation. They aren’t usually required to pay for the experimental treatment.
That might not be worrisome for some trials though. The study sponsor may provide treatment and tests at no cost to participants. Sponsors may also cover travel time, mileage and hotel stays. Patients should always be aware of their possible expenses if they join a clinical trial, and how much that costs compared to standard treatment.
Medical Debt from Cancer
Even with health insurance and proper financial planning, many cancer survivors or families of patients suffer from medical debt.
A study presented at the 2014 Palliative Care in Oncology Symposium found 27 percent of cancer survivors reported suffering a financial problem like debt or bankruptcy. Another 37 percent reported modifying work plans or delaying retirement.
Experts say one of the biggest financial mistakes patients make is letting bills pile up. It’s easy to do when faced with such a tragic diagnosis, but it often leads to even more problems in the future.
Individuals and families feel the financial burdens of cancer on personal levels, but it affects everyone on a larger scale.
Cancer’s Cost on Society
Cancer affects society on both global and national levels.
When pharmaceutical company CEO Martin Shkreli raised the price of a drug used in AIDS, malaria and cancer patients 5,000 percent the eyes of politicians lit up.
Presidential candidate Hilary Clinton proposed a plan that would allow the U.S. government and Medicare to negotiate prescription drug costs. Candidate Donald Trump called Shkreli a spoiled brat who ought to be ashamed of himself. Other candidates also proposed alternative healthcare plans they promised to implement if elected.
Facing enormous public pressure, Shkreli dropped the price of the drug.
The cost of cancer’s effect on society isn’t limited to political discussion. Work forces across the planet feel the impact.
A 2014 study in the International Journal of Cancer estimated the cost of lost productivity from cancer deaths in Europe was 75 billion euros ($84 billion), with breast cancer costing the most of any cancer at 7 billion euros ($7.84 billion) in lost productivity.
The cost affects hospitals and other healthcare facilities too. Many institutions rely on private donors to help keep cancer treatment available and affordable.
A recent study found almost half of doctors surveyed at 40 leading cancer centers were taught to identify patients who might be a good donor. One third of those surveyed had been asked to solicit a donation, but only half of that number agreed to do so.
The moment a doctor says the word cancer after a test or procedure, the lives of the patient and their families change. They’ll have a thousand questions to ask. They’ll wonder how much it will cost physically and emotionally.
Sadly, they’ll also have to determine how much cancer will cost financially.