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

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An Unhealthy AmericaMilken InstituteCOLON CANCERThe aging population and obesity trends push incidence and PRC higher, but declines in smoking and more widespreadscreening limit the increase. Smoking, which is typically associated with lung cancer, is a greater risk factor for coloncancer than are obesity and aging. Recent studies show that smokers are 30 percent to 40 percent more likely thannonsmokers to die of colon cancer.Incidence rates have been declining for nearly two decades, from 66.3 cases per 100,000 population in 1985 to 49.5 in2003. Deaths have dropped over the past fifteen years, in part because of improved screening. 48Age Demographics OnlyThe aging population will significantly affect incidence rates and PRC during the projection period, leading toa reversal in the downward trend. More than nine out of ten colon cancers are diagnosed in people over 50.The ratio of the incidence rate for the 65–74 age group relative to the 0–49 age group is 36.1. This means thatan individual between 65 and 74 is 36.1 times more likely to develop colon cancer than someone under 50. PRCjumps 51.2 percent, based upon aging alone, between 2003 and 2023. Fortunately, other factors will partiallyoffset this escalation.Baseline ScenarioAmong behavioral risk factors, only obesity is expected to have a deleterious impact on future PRC totals.Reductions in smoking and modest gains in exercise rates more than offset rising obesity impacts. At-risksmoking declines by roughly 3 percentage points over the next twenty years. This, with a modest improvementin physical activity, pushes PRC below where age alone would place it. Improved behavioral patterns cut apotential 45,532 cases (8.9 percent) relative to aging demographics. More widespread screening cuts another22,188 PRC in 2023. PRC increases to 446,752 (a 31.8 percent gain), or 19.4 percentage points below whereaging alone would push it.Colon cancer has the highest inpatient hospital care share (73.0 percent) of total treatment costs. Prescriptionmedications account for only 1.5 percent of treatment costs. Based on projections on medical care cost growth,expenditures per PRC will rise 103.3 percent between 2003 and 2023, an increase of 3.6 percent annually. Indollar amounts, expenditures per PRC rise from $11,549 in 2003 to $23,484.Total expenditures grow from $3.9 billion in 2003 to $10.6 billion in 2023, an increase of 171.8 percent. Thenation will spend $133.9 billion cumulatively over the next twenty years in overall treatment costs. Increasedscreening, lower smoking rates, changes in diet, improved physical activity, and declines in obesity are likelysources of cost containment and reductions in incidence and death.Optimistic ScenarioAt-risk smoking declines by another 2.7 percentage points. Physical activity improves, and the obesity ratepeaks in 2011, then falls to the rate last experienced in 1998. PRC is reduced by 63,927 relative to the baselineby 2023. Improved screening will reduce PRC by another 35,192. The optimistic scenario contains 78,931 fewer48. American Cancer Society, “Cancer Facts and Figures 2007.” Atlanta: American Cancer Society; 2007. p.12.[ 95 ]
An Unhealthy AmericaMilken InstitutePRC (down 17.7 percent) in 2023. The incidence rate will fall modestly over the period and edge up beginningin 2020, but remain below current levels. Expenditures per PRC are 9.2 percent lower ($2,166 less). Totaltreatment expenditures grow 102.5 percent between 2003 and 2023, reaching $7.93 billion.Direct Avoidable CostsBehavioral changes and improved screening lower future treatment expenditures by an appreciable amount.The difference between the baseline and optimistic expenditure projections provides an approximation of thedirect avoidable costs. By 2023, expenditures are 25.5 percent lower ($2.7 billion less) relative to the baseline.The cumulative difference between the two projections over the period is $21.7 billion.Colon CancerColon CancerPRC (Thousands) Expenditures Expenditures PRC* per ($) Expenditures/PRCTotal (US$ Billions)DemographicsDisease(Billions) (Millions) (Thousands)YearOnly Baseline Optimistic Baseline Optimistic Baseline Optimistic2003 Cancer 339 339 339 48.111,549 10.6 11,549 4.5 3.9 3.92023 Breast Cancer 512 447 368 5.523,484 1.1 21,319 10.6 4.87.9Percent Change Colon Cancer 3.9 0.3 11.52003-2023 51.2 31.8 8.5 103.3 84.6 171.8 102.5Lung Cancer 6.3 0.4 17.1Source: Milken InstituteProstate Cancer 4.3 1.0 4.1Other Cancers 28.0 7.7 3.6Pulmonary Conditions 45.2 49.2 0.9Diabetes Colon Cancer 27.1 - Avoidable 13.7 CostsColon Cancer2.0Hypertension Avoidable 32.5 Costs 36.8 0.9Heart Disease US$ Billions64.7 19.2 3.43.0Expenditures PRC* Expenditures/PRCStroke Expenditures 13.6 PRC* 2.4 Expenditures/PRC 5.6Disease(Billions) (Millions) (Thousands)Disease Mental Disorders (Billions) 45.8 (Millions) 30.3 (Thousands) 1.5Cancer2.548.1 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 Cancer Reporting ConditionColon5.5 1.1 4.82.0 Cancer 3.9 0.3 11.5Colon Cancer 3.9 0.3 11.5Lung Cancer 6.3 0.4 17.1Lung Cancer 6.3 0.4 17.1Prostate 1.5 Cancer 4.3 1.0 4.1ProstateOther CancersCancer28.04.3 1.07.74.13.6Other Cancers 28.0 7.7 3.6Pulmonary 1.0 Conditions 45.2 49.2 0.9PulmonaryDiabetesConditions 45.227.149.213.70.92.0Diabetes 27.1 13.7 2.0Hypertension 0.532.5 36.8 0.9Hypertension 32.5 36.8 0.9Heart Disease 64.7 19.2 3.4HeartStrokeDisease0.064.713.619.22.43.45.6Stroke 2005 2008 2011 13.620142017 2.4 2020 2023 5.6Mental Disorders Source: Milken Institute 45.8 30.3 1.5MentalTotalDisorders277.045.8162.230.3 1.51.7Total 277.0 162.2 1.7PRC: Population Reporting ConditionPRC: Population Reporting Condition[ 96 ]
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