An Unhealthy America: The Economic Burden of ... - Milken Institute

An Unhealthy AmericaMilken InstituteEarly Detection/Screening: Colon Cancer and Prostate CancerIn this model, we build in assumptions for early screening and detection to assess their impacts on colon andprostate cancer incidence rates. As noted earlier, when the PSA test was introduced, incidence rose as moremen underwent screening. But survival rates also improved dramatically, the result of early diagnoses thatprompted patients to alter unhealthy behaviors.Treatment: Heart Disease, Hypertension, and Stroke, Mental DisordersThe model also incorporates continued development of treatment advances where data are available abouthistorical trends. For example, prescription drugs that lower high blood pressure have reduced the probabilityor onset of heart attack significantly. Hypertension drugs comprise five classes: alpha blockers, beta blockers,calcium channel blockers, ACE inhibitors, and diuretics. Since the introduction of the first hypertension drug in1952, the number of drugs on the market has increased to fifty-three. In our model, the increasing growth inthe number of drugs available, particularly throughout the 1980s, has played a large role in determiningdisease prevalence. Treatments are also increasingly available for mental disorders.The impacts of these screening and treatments on baseline and optimistic incidence/prevalence rates are shown in thefollowing tables. The first table covers the six diseases for which we have data available. By 2023, the prostate cancerincidence rate declines considerably in the optimistic scenario, falling from 225.3 in the baseline to 176.9. Colon cancerincidence also falls by 17.7 percent in the optimistic scenario relative to the baseline. Heart disease and hypertensionprevalence rates decline by 34.5 percent and 18.8 percent, respectively. The second table depicts projections for theremaining diseases. Here we rely on changes in behavioral risk factors.Projections of Chronic Disease with Early Screening and TreatmentProjections of Chronic Disease with Early Screening and TreatmentExpendituresNew CasesPRC* Expenditures/PRCIncidence Rate**ThousandsPer 100,000 populationDisease(Billions) (Millions) (Thousands)Chronic Disease Year* Baseline Optimistic Baseline OptimisticColon Cancer 2003 147 48.1 147 10.6 50.4 4.5 50.4Breast Cancer2013 1595.51441.150.24.845.52023 193 159 56.1 46.2Prostate Cancer Colon Cancer 2003 217 3.9 217 0.3 151.8 11.5 151.8Lung Cancer2013 305 6.3 292 0.4 196.0 17.1 187.12023 381 299 225.3 176.9Prostate Cancer 4.3 1.0 4.1Cases with DiagnosisPrevalenceOther Cancers Thousands 28.0 7.7 Percent of U.S. population 3.6 25 and overChronic Pulmonary Disease Conditions Year* Baseline 45.2 Optimistic 49.2 Baseline 0.9OptimisticHypertensionDiabetes2003 46,82227.146,82213.724.82.024.82013 57,329 53,082 27.5 25.7Hypertension 2023 65,134 32.5 52,957 36.8 29.1 0.9 24.2Heart Disease Heart Disease2003 23,810 64.7 23,810 19.2 12.6 3.4 12.62013 28,795 24,988 13.8 12.1Stroke 13.6 2.4 5.62023 33,599 21,965 14.9 10.4Stroke Mental Disorders 2003 5,406 45.8 5,406 30.3 2.9 1.5 2.9Total2013 6,018277.05,573162.22.91.72.72023 6,970 5,657 3.2 2.7Mental Disorders PRC: Population Reporting 2003 Condition 30,338 30,338 10.4 10.42013 36,774 35,349 11.6 11.22023 46,673 40,910 13.6 11.9*Selected years for twenty-year projection** Male population was used for prostate cancer.Source: Milken Institute[ 87 ]