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

More documents

Recommendations

Info

An Unhealthy AmericaMilken InstituteBelow, we discuss the avoidable costs for each disease.BREAST CANCERBreast cancer is now the second leading cause of death among women, having fallen below lung cancer. 47 The agingpopulation and rising obesity will probably tip recent reductions in breast cancer incidence back to an upward trajectory.Decreased use of hormone replacement therapy will not have a meaningful effect on overall incidence. Diabetes andobesity show the strongest causal relationships.Breast cancer survival rates are improving with increased screening and self-examination. New treatments have provedeffective for both early and advanced breast cancer, and have reduced the need for more invasive surgery.Age Demographics OnlyBaby boomer aging will have a profound influence on breast cancer PRC totals over the next twenty years.Nearly eight of ten breast cancers are diagnosed in women over 50. The ratio of the incidence rate for the65–74 age group relative to the 0–49 age group is 9.4. This means that a woman between 65 and 74 is 9.4 timesmore likely to develop breast cancer than a woman under 50.To project breast cancer PRC figures, we maintain age-specific incidence rates at their 2003 levels and hold allother factors constant. PRC for breast cancer rises 39.5 percent between 2003 and 2023.Baseline ScenarioAfter aging, obesity will have the most deleterious effect on breast cancer PRC through 2023. Baselineassumptions call for obesity to increase at a rate slightly below that of the recent past and to plateau after 2015.We apply the obesity behavioral risk factor (captured in the pooled fifty-state model) to the aging populationto calculate the extent to which obesity will influence breast cancer PRC. Combined with aging, rising obesitycauses the baseline PRC projection to increase by 50.8 percent between 2003 and 2023. This is 11.3 percentagepoints greater than aging alone. Rising obesity adds 128,404 to the PRC total in 2023, when it reaches1,719,170.Unlike prostate, colon and lung cancer treatment, breast cancer treatment relies more on prescription drugsthan inpatient care (just 22 percent of expenditures were directed to inpatient hospital care versus 73 percentfor colon cancer in 2003). Consistent with health-care cost growth projections, breast cancer expenditures perPRC rise 86.6 percent, an increase of 3.2 percent annually. In dollar amounts, expenditures per PRC grow from$4,840 in 2003 to $9,033 in 2023.Treatment expenditures jump from $5.5 billion to $15.6 billion, a 182.2 percent increase. Over the next twodecades, the health-care system will spend $205 billion on treatment. Reducing obesity will be the most likelyway to contain costs and reduce disability and death.47. American Cancer Society, “Cancer Facts and Figures 2007.” Atlanta: American Cancer Society; 2007. p.9.[ 93 ]
An Unhealthy AmericaMilken InstituteOptimistic ScenarioThe projected path for obesity drops as health initiatives catch on over the coming decades. The obesity ratepeaks in 2011 and falls to the rate last experienced in 1998. Breast cancer PRC grows by 32.2 percent—but thetotal is down by 211,414 PRC, or 12.3 percent.Expenditures per PRC are based on an assumption of lower growth in medical care costs, increasing0.5 percentage point slower per year than in the baseline. Thus, expenditures per PRC are 9.3 percent less (or$836 lower) by 2023. Total expenditures increase 124.1 percent between 2003 and 2023, reaching $12.4 billion.Direct Avoidable CostsReduced obesity rates lower future treatment expenditures. The difference between the baseline andoptimistic expenditure projections provides an estimate of the direct avoidable costs. In 2023, expendituresare 20.6 percent lower ($3.2 billion lower) in the optimistic scenario. The cumulative difference over the periodis $22.3 billion.Breast CancerBreast CancerPRC (Thousands) Expenditures Expenditures PRC* per PRC ($) Expenditures/PRCTotal (US$ Billions)DemographicsYear Disease Only Baseline Optimistic (Billions) Baseline (Millions) Optimistic (Thousands)Baseline Optimistic2003 Cancer1,140 1,140 1,140 48.1 4,840 10.64,840 4.5 5.5 5.52023 Breast 1,591 Cancer 1,719 1,508 5.5 9,033 1.18,196 15.6 4.812.4Percent Change Colon Cancer 3.9 0.3 11.52003-2023 39.5 50.8 32.2 86.6 69.3 182.2Lung Cancer 6.3 0.4 17.1Source: Milken Institute124.1Prostate Cancer 4.3 1.0 4.1Other Cancers 28.0 7.7 3.6Pulmonary Conditions 45.2 49.2 0.9Diabetes Breast Cancer Breast 27.1- Avoidable Cancer 13.7 Costs2.0Hypertension Avoidable 32.5 Costs 36.8 0.9Heart Disease US$ Billions64.7 19.2 3.43.5Expenditures PRC* Expenditures/PRCStroke Expenditures 13.6 PRC* 2.4 Expenditures/PRC 5.6Disease(Billions) (Millions) (Thousands)Disease Mental 3.0 Disorders (Billions) 45.8 (Millions) 30.3 (Thousands) 1.5Cancer 48.1 10.6 4.5Cancer Total 277.0 48.1 162.2 10.6 4.5 1.7Breast Cancer 5.5 1.1 4.8PRC: Breast Population 2.5 Cancer Reporting ConditionColon Cancer5.53.91.10.3 11.54.8Colon Cancer 3.9 0.3 11.5Lung Cancer 6.3 0.4 17.1Lung Cancer 2.06.3 0.4 17.1Prostate Cancer 4.3 1.0 4.1ProstateOtherCancer 4.3 1.0 4.11.5 Cancers 28.0 7.7 3.6Other Cancers 28.0 7.7 3.6Pulmonary Conditions 45.2 49.2 0.9PulmonaryDiabetes 1.0Conditions 45.227.149.213.70.92.0Diabetes 27.1 13.7 2.0Hypertension 32.5 36.8 0.9Hypertension 0.532.5 36.8 0.9Heart Disease 64.7 19.2 3.4HeartStrokeDisease 64.713.619.22.43.45.6Stroke 0.013.6 2.4 5.6Mental Disorders 2005 2008 2011 45.8 2014 2017 30.3 2020 2023 1.5MentalTotalDisorders Source: Milken Institute 277.045.8162.230.3 1.51.7Total 277.0 162.2 1.7PRC: Population Reporting ConditionPRC: Population Reporting Condition[ 94 ]
Page 8:
An Unhealthy AmericaMilken Institut
Page 11 and 12:
iitime of the analysis show that th
Page 13 and 14:
Existing estimates of the economic
Page 16 and 17:
Page 18 and 19:
Page 20:
Page 23 and 24:
Page 25 and 26:
Page 28 and 29:
Page 30 and 31:
Page 32 and 33:
Page 34 and 35:
Page 36:
Page 39 and 40:
Page 42 and 43:
Page 44:
Page 48 and 49:
Page 50 and 51:
Page 52 and 53:
Page 54 and 55:
Page 56 and 57: An Unhealthy AmericaMilken Institut
Page 80: An Unhealthy AmericaMilken Institut
Page 156 and 157:
Page 160 and 161:
Page 162:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 180 and 181:
Page 182 and 183:
Page 184 and 185:
Page 186 and 187:
Page 188 and 189:
Page 190 and 191:
Page 192 and 193:
Page 194 and 195:
Page 196 and 197:
Page 198 and 199:
Page 200 and 201:
Page 202 and 203:
Page 204 and 205:
Page 206 and 207:
Page 208 and 209:
Page 210 and 211:
Page 212 and 213:
Page 214 and 215:
Page 216 and 217:
Page 218 and 219:
Page 220 and 221:
Page 222 and 223:
Page 224 and 225:
Page 226 and 227:
Page 228 and 229:
Page 230 and 231:
Page 232 and 233:
Page 234 and 235:
Page 236 and 237:
Page 238 and 239:
Page 240 and 241:
Page 242 and 243:
Page 244 and 245:
Page 246 and 247:
Page 248 and 249:
Page 250 and 251:
Page 252:
1250 Fourth Street • Santa Monica
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?